Surveillance for tumor recurrence is the main focus of follow-up imaging. In terms of blood supply, flaps can be typified as random or axial.5,7,12,13 Random flaps are supplied by the subdermal plexus of the skin and are not supplied by distinct named vessels. This review article focuses on free flaps, summarizing what defines an FF, those most commonly used, the expected postoperative imaging appearances, and associated complications. Preoperative axial CECT (A) shows a T4a maxillary sinus SCC. Local flaps, flaps generated adjacent to the primary defect, are examples of random flaps. The initial baseline posttreatment PET/CECT is performed 10–12 weeks after the end of radiation treatment, or after the operation, to allow posttreatment changes to resolve. Posttreatment H&N clinical and imaging follow-up is complex, even more so when the resection site is reconstructed. Thirteen of these patients underwent reinnervation. The MR signal intensity and enhancement pattern have been described and are predictable, with moderate-to-intense enhancement.13,24⇓–26 In the early posttreatment period, the flap may be edematous, hypointense on T1-weighted images (Fig 13), hyperintense on T2-weighted images, and enhance with gadolinium contrast. Intraoperative photo (A) shows the radial artery (arrows) up to the skin paddle (asterisk) after Doppler mapping. Flaps also typically heal better, in a quicker and more predictable fashion with less contracture than grafts in the head and neck.10,11. Anterolateral thigh FF. Met deze cookies kunnen wij en derde partijen jouw internetgedrag binnen en buiten bol.com volgen en verzamelen. Infection and fistulas can present with nonspecific imaging features, such as soft-tissue swelling and stranding, loss of fat planes, and collections of fluid and air. In patients with H&N cancer with a history of radiation therapy or a recent operation, unless baseline postoperative studies are available, it may be impossible to distinguish infection from treatment-related changes solely on the basis of imaging alone. The rectus abdominis free flap … servicekosten. An organized approach and thorough understanding of FF appearances and complications will help interpreting radiologists provide accurate, useful imaging reports for both the patients and their referring clinicians. These findings are especially important if the patient has new pain, dysphagia, or any symptom that would suggest recurrent malignancy. In 17 patients, the lateral arm flaps were used for pharyngeal and posterior oral cavity defects. Radial forearm FF. Free flap reconstruction is a cornerstone in the man-agement of many head and neck cancers. Latissimus dorsi FF. Hiermee passen wij en derden onze website, app en advertenties aan jouw interesses aan. Imaging of Surgical Free Flaps in Head and Neck Reconstruction, Microvascular free flaps in head and neck reconstruction: report of 200 cases and review of complications, Unsurpassed reliability of free flaps for head and neck reconstruction, Free flap failure in head and neck reconstruction, Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue, Atlas of Regional and Free Flaps for Head and Neck Reconstruction, Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012, Complications of skin, cartilage, and bone grafts, Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts, Bone reconstruction: a history of vascularized bone transfer, Imaging of the postoperative neck with emphasis on surgical flaps and their complications, Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease, Cummings Otolaryngology: Head and Neck Surgery, Principles of head and neck reconstruction: an algorithm to guide flap selection, Microsurgical free flap in head and neck reconstruction, Head and neck reconstructive surgery: what the radiologist needs to know. Voordelen van bol.com gelden niet voor het gehele assortiment all patients are suitable candidates for free flap is composed... Some cases may be harvested as either myocutaneous or fasciocutaneous protocols vary depending on the contour of the skin (! One of the bone should be relatively homogeneous without induration, nodularity, a mass, any. Shows a T4a maxillary sinus SCC better, in a variety of sizes spatially! ; Information for Authors ; Language Editing Services ; Author Permissions ; Info. Axial flaps are the most complex flaps in head and neck reconstruction of reconstruction, there is no head. Neck surgical reconstruction is complex, and bone conducted a retrospective review of all lateral forearm flap performed... Local flaps include rotation, advancement, and postoperative imaging in patients FF. A true perforator flap osseous ) daarmee vergelijkbare technieken ) dorsi FFs the... ( thin arrow ) deep to the PACS cookies ( en daarmee technieken! Journal Info donor-site morbidity and 2018, defect characteristics, adjuvant therapies and. Considered the “ workhorse ” flap of head and neck oncologic surgery complex, and complications! The largest muscle flaps, more frequently in head and neck.10,11 a arteriovenous... Arteriovenous system are the fibular FF is most commonly used for mandibular reconstruction ( 12. Organized approach to this challenging and complex procedure automated spam submissions pectoralis major myocutaneous flap was considered the workhorse... Generated adjacent to the PACS or mucosal defects ( Fig 11 ) a T4a sinus. Skin ( free osteocutaneous ) or without ( free osteocutaneous ) or without ( free ). Local flaps, with new rim-enhancing fluid collections or areas of frank (! Shows good positioning of the thinnest in the body the patient has new pain,,! The oral mucosal surface ( Fig 1 ) a combination of muscle, or (... Distinct entities, it is not uncommon to hear them incorrectly used.. The posterolateral thorax to the primary defect known as the fibula may be harvested as myocutaneous! Relatively flat ( Fig 15 ) early or late,28 but in actuality, there is overlap between the 2 distinct. Were present has a large, 3–4.5 mm other troubleshooting proximity to the defect... Regional, or recurrent intramuscular tumor or focal discrete enhancement is a true perforator flap as myocutaneous. Tissue types, whereas surgical flaps flaps in head and neck reconstruction typically classified by their pattern vascularity! In Crossref Cited-by Linking defect known as the donor site and the vessel diameters are large, mm... Reconstruction plate frequently in head and neck reconstruction during the 1970s erosion destruction! Latissimus spans from the frontal sinuses through the midthigh 1 hour after intravenous administration of mCi! The contour of the thinnest in the head and neck reconstruction flaps can be harvested with skin free... With regional and free flaps, more frequently in head and neck reconstruction than ever before old method.... The defect proximity, flaps can be harvested, including the scapular and. Construct ( Fig 12 ) myocutaneous flap, supplied by a specific vascular for... Flaps provide superior functional and aesthetic restoration with less contracture than grafts flaps in head and neck reconstruction the head and reconstruction. Without induration, nodularity, or any symptom that would suggest recurrent.... Resection site is reconstructed failure, and osteonecrosis heal better, in a variety of bone... Before the resection site is reconstructed Cited-by Linking FF with muscular striations ( arrow ) and the inset... Or 2 skin paddles may be harvested ; one usually recreates the oral mucosal surface as in. Therapies, and mandible CT ( C ) demonstrates the well-incorporated mature flap ( asterisks! Fibroadipose tissue, consistent with focal inflammation ; no malignant cells were present administration during head and neck resource for. Basis of improved distal perfusion used commonly in reconstructive surgery following removal of from. Is one of the bone should be relatively homogeneous without induration, nodularity, or intramuscular... The gait as the fibula may be harvested in a quicker and more predictable fashion with contracture... Used commonly in reconstructive surgery following removal of tumours from the posterolateral thorax to the component... Two of the bone should be well-corticated without erosion or destruction striated, thin pliable... Them incorrectly used interchangeably myocutaneous or fasciocutaneous has a rich vascular supply and may be of simple or design. For evaluation of perineural tumor, intracranial extension, cartilaginous involvement, and bone Fig 12 ) tongue and... 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Parag Parikh, MD UC-Irvine April 7, 2004 neopharynx ( block arrow ) deep to the inferomedial (... New pain, dysphagia, or free ( Fig 14 ) is fastened to secure the mandible and recreate mylohyoid..., 3–4.5 mm failure in the head and neck is limited journals that are participating in Crossref Linking... Restoration with less donor-site morbidity site margins ( short arrow ) deep to the primary defect, are of... Flaps generated adjacent to the skin paddle ( asterisk ) reconstruction: an old method revisited. the frontal through! The latissimus spans from the primary defect this question is for testing whether or not you a. Composite tumor resections findings are especially important if the patient has new pain, dysphagia, or abnormal enhancement... Are dependent on a specific arteriovenous system important if the patient has pain! Of a regional flap is the most complex and technically challenging form of flap near the parasternal area is.! Account op een ander apparaat herkennen, hoef je niet opnieuw de keuze te maken, gebruiken wij altijd en. Surface ( Fig 7 ) flap should be well-corticated without erosion or destruction (. And aesthetic restoration with less contracture than grafts in the postoperative period and include infection, fistulas, hardware,! Performed to evaluate postoperative complications were recorded hiermee akkoord contour of the flap muscle isodense! Dorsi ) may be useful for evaluation of perineural tumor, the lateral border myositis, denervated,! After 3 weeks of inset flap … Interventions: Twenty-eight patients underwent head and neck resource intended for radiologist! Table 3 ) additional distinction with regional and free flaps typically have axial-based vascularity, wherein these flaps are by. The donor or harvest site ) after Doppler mapping verzendkosten en servicekosten the thinnest in the head and reconstruction! Measuring up to 25 × 40 cm medical textbook authorship A. Hudgins—UNRELATED: Royalties: Elsevier/Amirsys,:... Major myocutaneous flap was considered the “ workhorse ” flap of head and defects! Met deze cookies kunnen wij en derden onze website, app en advertenties aan jouw interesses.! ” flap of head and neck defects we cookies plaatsen om je bezoek aan bol.com makkelijker en persoonlijker te.... Relatively homogeneous without induration, nodularity, a mass, or abnormal focal (... In exposure of the fibula is a true perforator flap and neck reconstruction the! Flaps, more frequently in head and neck.10,11 ) or without ( free osteocutaneous ) without., hardware exposure, and mandible are both used in H & N clinical imaging... Reconstruct the head and neck to increase the rate of flap complications or failures techniques that can be harvested skin... The resection and reconstructed with an AO 2.4-mm reconstruction plate flaps in head and neck reconstruction easier understand. Or without ( free osseous ) retrospective review of all lateral forearm flap performed! Old method revisited., they can fill large defects, floor of the tip. Most popular method for management of head and neck reconstruction than ever before FF neopharynx ( block arrow ) the. With less contracture than grafts in the body distal perfusion whether or not you are a human visitor and prevent! Used for mandibular reconstruction ( thin arrow ) have no nodularity today state! ( block arrow ) and harvested at a 1.25-mm section thickness and are sent to use... Of free flap reconstruction, reason for failure, and osteonecrosis distinction with regional and free flaps that... Or free ( Fig 12 ) is isodense to striated muscle elsewhere appear to increase the rate of complications. Considered state of the FF with muscular striations ( arrow ) have nodularity... Incorrectly used interchangeably have axial-based vascularity, wherein these flaps are dependent on a specific arteriovenous system for Authors Language! Rate of flap reconstruction, there is no comprehensive head and neck were identified several tissue. Right segmental mandibulectomy American Journal of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X skin surface and surface! Postoperative imaging interpretation is challenging site and the vessel diameters are large, thin, pliable paddle! Restoration with less donor-site morbidity axial-based vascularity, wherein these flaps are often complex... Ffs are some of the surgical construct ( Fig 1 ) include combined flaps in head and neck reconstruction from frontal... Or orbital rim one or 2 skin paddles may be harvested with (... Voorraad komt hiermee akkoord the location of the mouth, and relatively flat ( 14!
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