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Nsw speech-path-talk-flapvs-grafts
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- 3. “….the application of anatomicalknowledge to restore form and function…”
- 4. Graft VS Flap Whatis the difference?
- 5. What is aFlap? • 16th century Dutch word “flappe” – ….something that hangs broad and loose , fastened only by one side..”
- 6. What is aFlap? • A flap is a unit of tissue that may be transferred from a donor to a recipient site while maintaining its blood supply. – Flaps can be characterized by their component parts • cutaneous, musculocutaneous, osseocutaneous – Their relationship to the defect • local, regional, or distant – Nature of the blood supply • random versus axial – The movement placed on the flap • advancement, pivot, transposition, free, pedicled
- 7. • Rung 1:Healing by secondary intention • Rung 2: Primary closure • Rung 3: Delayed primary closure • Rung 4: Split thickness graft • Rung 5: FTSG • Rung 6: tissue expansion • Rung 7: Random flap • Rung 8: Axial flap • Rung 9: Free Flap

- 8. Reconstructive Elevator • Getoff at the right level
- 9. Composition of aflap • Skin – Muscle – Bone – Omentum – Composite
- 10. Composition of aflap – Skin • Muscle – Bone – Omentum – Composite
- 11. Composition of aflap – Skin – Muscle • Bone – Omentum – Composite
- 12. Composition of aflap – Skin – Muscle – Bone • Omentum – Composite
- 13. Composition of aflap – Skin – Muscle – Bone • Omentum / viscera – Composite
- 14. Composition of aflap – Skin +/- fascia – Muscle (+/- innervation) – Bone – Omentum / viscera • Composite
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- 16. Goals of reconstruction •Separating the physiological cavities – Eg brain, orbit, mouth, neck • Protecting the neck vessels • Obtaining a healed wound • Restore function • Restore swallowing • No leaks • Aesthetics
- 17. • Flaps reducecomplications by: – Obliterating dead space – Recruiting healthy well-vascularized tissue into the region, which has commonly been irradiated and contaminated – Tension free closure – Interposing flap skin between irradiated wound edges
- 18. Pharyngeal defects • Partialdefects – Pectoralis major flap with muscle and skin – Radial forearm free flap • Circumferential defects – Tubed radial forearm flap or ALT flap – Jejunum
- 19. Goals of reconstruction: • A single stage, reliable reconstruction • Prompt discharge from hospital • Return of swallowing and speech function • No salivary fistulas
- 36. Literature Review • Nelligan(J PlastReconstrAesthet Surg. 2008) reported a fistula rate of: – 13% for all fasciocutaneous flaps • ALT flap 16.4% • radial forearm free flap 14.4%. – Jejunum 9.4% • Charing Cross Study (Moradi et al) – fistula rate: 2/43 (4.7%) – stricture rate: 6/43 (14%)
- 37. Murray D, NovakC, Neligan P. Fasciocutaneous free flaps in pharyngolarngo- oesophageal reconstruction: A critical review of literature. J PlastReconstrAesthet Surg. 2008
- 38. Voice Restoration (CharingCross series) • 22 of 42 received a primary (TEP) • 14 of 42 received a secondary TEP • 36/42 (85%) received either a primary or secondary TEP • Voice was reported as: – Good in 17 of 39 – Fair in 11 of 39. – 28 of 39 (72%) used their tracheoesophageal puncture as their primary mode of communication
- 39. When to eat? •No scientific evidence on the timing of oral intake • Err on the side of caution if previous radiotherapy • Day 10
- 40. Mandible reconstruction • Osteoradionecrosis(ORN) is a condition of non-vital bone in a site of radiation injury • Characterised by: – hypovascularity – hypocellularity – hypoxia • ORN occurs when, in the process of otherwise normal turnover of bone, the degradative function exceeds new bone production • Can be either spontaneous or the result of an insult
- 46. Facial reanimation • Goalof treatment – Rest symmetry – Facial function – Voluntary function – Spontaneous movement – Absence of synkinesis
- 47. Facial reanimation • Staticvs dynamic • Static: Divide face into 1/3rds – Upper: – Middle: – Lower:
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- 50. Tongue reconstruction • Dependingon extent of defect and the status of the floor of mouth • Generally use: – Radial forearm free flap – Ulnar forearm free flap – ALT
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