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Semin Plast Surg 2023; 37(01): 073-082
DOI: 10.1055/s-0042-1760444
Review Article

Flap Debulking and Secondary Revisions in Head and Neck Reconstruction: A Systematic Review with Clinical Applications

Olatunde H. Bashorun
1   Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
,
R. Michael Johnson
1   Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio
,
Elise A. Johnson
2   Department of Plastic and Reconstructive Surgery, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Ross University Medical School, Bridgetown, Barbados
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Abstract

Flap debulking and secondary revisions are an integral factor in providing optimum outcomes to reconstructive patients. This review article summarizes systematically the available literature on flap debulking in head and neck reconstruction. The clinical applications of debulking techniques are discussed, including fractional direct excision, liposuction, and single-stage excision or planning with skin grafting. New technologies are also discussed.

Keywords

debulking - head and neck - reconstruction - contour - revision - timing


Publication History

Article published online:
09 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Elgohary H, Nawar AM, Zidan A, Shoulah AA, Younes MT. Functional and aesthetic outcomes of reconstruction of soft-tissue defects of the heel with free flap. JPRAS Open 2018; 19: 35-44
    CrossrefPubMedGoogle Scholar
  • 2 Klinkenberg M, Fischer S, Kremer T, Hernekamp F, Lehnhardt M, Daigeler A. Comparison of anterolateral thigh, lateral arm, and parascapular free flaps with regard to donor-site morbidity and aesthetic and functional outcomes. Plast Reconstr Surg 2013; 131 (02) 293-302
    CrossrefPubMedGoogle Scholar
  • 3 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62 (10) e1-e34
    CrossrefPubMedGoogle Scholar
  • 4 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological Index for Non-randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    CrossrefPubMedGoogle Scholar
  • 5 Hanasono MM, Skoracki RJ, Silva AK, Yu P. Adipofascial perforator flaps for “aesthetic” head and neck reconstruction. Head Neck 2011; 33 (10) 1513-1519
    CrossrefPubMedGoogle Scholar
  • 6 Tan NC, Cigna E, Varkey P, Liu Y-T. Debulking of free myocutaneous flaps for head and neck reconstruction using an arthroscopic shaver. Int J Oral Maxillofac Surg 2007; 36 (05) 450-452
    CrossrefPubMedGoogle Scholar
  • 7 Lai H-T, Kuo P-J, Chang C-H, Lai C-S, Lin S-D, Kuo Y-R. Combined use of liposuction and arthroscopic shaving for delayed debulking of free flaps in head and neck reconstruction. Ann Plast Surg 2018; 80 (2S Suppl 1): S36-S39
    CrossrefPubMedGoogle Scholar
  • 8 Cigna E, Minni A, Barbaro M. et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction. Eur Rev Med Pharmacol Sci 2012; 16 (08) 1095-1101
    PubMedGoogle Scholar
  • 9 Spyriounis PK, Lutz BS. Versatility of the free vastus lateralis muscle flap. J Trauma 2008; 64 (04) 1100-1105
    PubMedGoogle Scholar
  • 10 Wolff K-D, Kesting M, Thurmüller P, Böckmann R, Hölzle F. The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery. J Craniomaxillofac Surg 2006; 34 (06) 323-331
    CrossrefPubMedGoogle Scholar
  • 11 Liu S-C, Chiu W-K, Chen S-Y, Lee T-P, Wang H-W, Chen S-G. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg 2011; 39 (08) 633-638
    CrossrefPubMedGoogle Scholar
  • 12 Park SS. Revisiting the single-stage forehead flap in nasal reconstruction. JAMA Facial Plast Surg 2013; 15 (05) 383-384
    CrossrefPubMedGoogle Scholar
  • 13 Gharb BB, Salgado CJ, Moran SL. et al. Free anterolateral thigh flap in pediatric patients. Ann Plast Surg 2011; 66 (02) 143-147
    CrossrefPubMedGoogle Scholar
  • 14 Sadigh PL, Hsieh C-H, Feng G-M, Shih H-S, Jeng S-FA. A “green” approach to secondary reconstruction: the concept of the recycle flap and a classification. Plast Reconstr Surg 2015; 135 (02) 401e-412e
    CrossrefPubMedGoogle Scholar
  • 15 Ozkan O, Coskunfirat OK, Ozgentas HE, Derin A. Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes. J Reconstr Microsurg 2005; 21 (08) 539-545
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Goh TLH, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap–a review of 210 cases. Plast Reconstr Surg 2015; 135 (02) 592-601
    CrossrefPubMedGoogle Scholar
  • 17 Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW. Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope 2012; 122 (12) 2663-2669
    CrossrefPubMedGoogle Scholar
  • 18 Higgins KM, Erovic BM, Ravi A. et al. Volumetric changes of the anterolateral thigh free flap following adjuvant radiotherapy in total parotidectomy reconstruction. Laryngoscope 2012; 122 (04) 767-772
    CrossrefPubMedGoogle Scholar
  • 19 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26 (09) 759-769
    CrossrefPubMedGoogle Scholar
  • 20 Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg 1986; 78 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 21 El-Marakby HH. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst 2006; 18 (01) 41-50
    PubMedGoogle Scholar
  • 22 Hu J, Yin L, Tang X, Gui L, Zhang Z. Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome. J Craniofac Surg 2011; 22 (03) 937-941
    CrossrefPubMedGoogle Scholar
  • 23 Haddock NT, Saadeh PB, Siebert JW. Achieving aesthetic results in facial reconstructive microsurgery: planning and executing secondary refinements. Plast Reconstr Surg 2012; 130 (06) 1236-1245
    CrossrefPubMedGoogle Scholar
  • 24 D'Souza JN, Valika T, Maddalozzo J. Surgical management of midline cervical cleft. Int J Pediatr Otorhinolaryngol 2019; 127 (109657): 109657
    CrossrefPubMedGoogle Scholar
  • 25 Song B, Li Y, Wang B. et al. Treatment of severe hemifacial atrophy with dorsal thoracic adipofascial free flap and concurrent lipoinjection. J Craniofac Surg 2015; 26 (02) e162-e166
    CrossrefPubMedGoogle Scholar
  • 26 Disa JJ, Rodriguez VM, Cordeiro PG. Reconstruction of lateral skull base oncological defects: the role of free tissue transfer. Ann Plast Surg 1998; 41 (06) 633-639
    CrossrefPubMedGoogle Scholar
  • 27 Fan S, Wang Y-Y, Wu D-H. et al. Intraoral lining with the fibular osteomyofascial flap without a skin paddle during maxillary and mandibular reconstruction. Head Neck 2016; 38 (Suppl. 01) E832-E836
    CrossrefPubMedGoogle Scholar
  • 28 Rüegg EM, Gniadek P, Modarressi A, Baratti-Mayer D, Pittet-Cuénod B. Facial bone reconstruction with prefabricated vascularized calvarium flaps in children and young adults: advantages and long-term results. J Craniomaxillofac Surg 2016; 44 (12) 1880-1888
    CrossrefPubMedGoogle Scholar
  • 29 Dornhoffer JL. Surgical modification of the difficult mastoid cavity. Otolaryngol Head Neck Surg 1999; 120 (03) 361-367
    CrossrefPubMedGoogle Scholar
  • 30 Wooden WA, Shestak KC, Newton ED, Ramasastry SS. Liposuction-assisted revision and recontouring of free microvascular tissue transfers. Aesthetic Plast Surg 1993; 17 (02) 103-107
    CrossrefPubMedGoogle Scholar
  • 31 Garg RK, Poore SO, Wieland AM, Mcculloch TM, Hartig GK. Elective free flap revision in the head and neck cancer patient: indications and outcomes. Microsurgery 2015; 35 (08) 591-595
    CrossrefPubMedGoogle Scholar
  • 32 Cigna E, Sassu P, Varkey P, Tan NC, Liu Y-T. Debulking of free perforator flaps for head and neck reconstruction using an arthroscopic shaver. Ann Plast Surg 2005; 55 (04) 441
    CrossrefPubMedGoogle Scholar
  • 33 Parrett BM, Pomahac B, Orgill DP, Pribaz JJ. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg 2007; 120 (07) 1871-1878
    CrossrefPubMedGoogle Scholar
  • 34 Howard BE, Nagel TH, Barrs DM, Donald CB, Hayden RE. Reconstruction of lateral skull base defects: a comparison of the submental flap to free and regional flaps. Otolaryngol Head Neck Surg 2016; 154 (06) 1014-1018
    CrossrefPubMedGoogle Scholar
  • 35 Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994; 93 (03) 472-478 , discussion 479–480
    CrossrefPubMedGoogle Scholar
  • 36 Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S. Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg 2010; 24 (02) 148-154
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg 2002; 109 (06) 1839-1855 , discussion 1856–1861
    CrossrefPubMedGoogle Scholar
  • 38 Kim TG, Choi MK. Secondary contouring of flaps. Arch Plast Surg 2018; 45 (04) 319-324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Huang SH, Wu SH, Chang KP. et al. Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure. J Craniomaxillofac Surg 2009; 37 (04) 201-205
    CrossrefPubMedGoogle Scholar
  • 40 Hallock GG. Conventional liposuction-assisted debulking of muscle perforator flaps. Ann Plast Surg 2004; 53 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 41 Salgarello M, Barone-Adesi L, Cina A, Farallo E. The effect of liposuction on inferior epigastric perforator vessels: a prospective study with color Doppler sonography. Ann Plast Surg 2005; 55 (04) 346-351
    CrossrefPubMedGoogle Scholar
  • 42 Reuben CM, Bastidas N, Sharma S. Power-assisted suction lipectomy of fasciocutaneous flaps in the extremities. Ann Plast Surg 2010; 65 (01) 60-65
    CrossrefPubMedGoogle Scholar