1/5. Repair of the pharyngocutaneous fistula with a fasciocutaneous island flap pedicled on the superficial temporalis artery.The case of an 84-year-old man with a pharyngocutaneous fistula after radiotherapeutic treatment and total laryngectomy for a squamous cell carcinoma was reported. Treatment with local flaps failed and normal flaps were not likely to succeed because of general and locally poor conditions considering that intensive radiotherapy had been administered. We therefore decided to use a fasciocutaneous island flap from the temporoparietal region pedicled on the parietal branch of the superficial temporalis artery. We obtained efficient and stable repair of the lesion both from a cosmetic and a functional point of view. We were forced to use this procedure for lack of another choice; however, we think that this could become a useful option in covering substance loss in this area when simpler solutions are not available.- - - - - - - - - - ranking = 1keywords = island (Clic here for more details about this article) |
2/5. Repair of a pharyngo-cutaneous fistula.A method for closure of a midline pharyngo-cutaneous fistula by providing lining from an epidermal island on a cervical skin flap and outer cover from a split skin graft has been described. It can be useful in selected cases.- - - - - - - - - - ranking = 0.2keywords = island (Clic here for more details about this article) |
3/5. Repair of pharyngocutaneous fistulas with the submental artery island flap.Pharyngocutaneous fistulas after total laryngectomy are difficult to manage and are a cause for significant morbidity to the patient. When fistulas fail to close with conservative measures, debridement and flap closure are indicated. Although a number of techniques to repair pharyngocutaneous fistulas are described, each of these procedures has its drawbacks. The authors have used the submental island flap to close postoperative pharyngocutaneous fistulas in nine male patients during the past 4 years. The mean patient age was 65 years (range, 57 to 75 years). The submental island flap is based on the submental artery, a branch of the facial artery. The inner aspect of the fistula was initially formed using hinge flaps on the skin around the fistula. Once a watertight closure of inner side was created, the skin defect was closed with the submental island flap. The maximum flap size was 6 x 3 cm and the minimum size was 4 x 2 cm (average, 4.8 x 2.7 cm) in this series. Direct closure was achieved at all donor sites. patients were followed for 6 months to 4 years. No major complication was noted in the postoperative period. All patients have successfully recovered their swallowing function. The submental island flap is safe, rapid, and simple to elevate and leaves minimal donor-site morbidity. The authors believe that this technique is a good alternative in the reconstruction of pharyngocutaneous fistulas. Application of the technique and results are discussed.- - - - - - - - - - ranking = 1.6keywords = island (Clic here for more details about this article) |
4/5. Deltopectoral island flap.The medially based deltopectoral flap is a proven, reliable, and useful tool in the practice of head and neck and reconstructive surgery. Despite its versatility the flap has several limitations that restrict its use; these include a limited arc of rotation and significant risk of distal flap necrosis when increased length is incorporated from the deltoid region. By conversion of the conventional, parasternally based deltopectoral flap into an island flap supplied by one or two perforating branches of the internal mammary artery, its versatility can be markedly enhanced. This modification provides a free axis of rotation with virtually unrestricted spatial orientation and critical additional length. Furthermore, the island flap itself can be incorporated into the donor-site region, allowing primary closure of this defect. The dependability of this flap stems from the axial nature of the blood supply to the pectoral region. This factor, together with the free axis of rotation, affords the island flap its superiority over the standard deltopectoral flap. We have used this flap a total of 19 times (16 island and 3 free flaps) with notable clinical success and no observed failures. A description of technique and clinical applications will be discussed.- - - - - - - - - - ranking = 1.6keywords = island (Clic here for more details about this article) |
5/5. Cervical necrotising fasciitis with pharyngeal perforation: treatment and reconstruction.We present a case of life-threatening necrotising fasciitis of the neck with acute pharyngeal perforation following a parapharyngeal abscess caused by tonsillitis. The joint occurrence of cervical necrotising fasciitis and acute pharyngeal perforation has not been previously reported. A new way of reconstructing the pharyngeal defect using an islanded submental perforator flap is presented.- - - - - - - - - - ranking = 0.2keywords = island (Clic here for more details about this article) |