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Leckenby, Jonathan,Butler, Daniel,Grobbelaar, Adriaan Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.1
The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.
Jonathan Leckenby,Daniel Butler,Adriaan Grobbelaar 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.1
The latissimus dorsi flap is popular due to the versatile nature of its applications. When usedas a pedicled flap it provides a robust solution when soft tissue coverage is required followingbreast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to themuscle’s size, constant anatomy, large caliber of the pedicle and the fact it can be used forfunctional muscle transfers. In facial palsy it provides the surgeon with a long neurovascularpedicle that is invaluable in situations where commonly used facial vessels are not available,in congenital cases or where previous free functional muscle transfers have been attempted,or patients where a one-stage procedure is indicated and a long nerve is required to reachthe contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach,an operative guide of raising the flap by this method has not been provided. A clear guide ofraising the flap with the patient in the supine position is described in detail and offers thebenefits of reducing the risk of potential brachial plexus injury and allows two surgical teamsto work synchronously to reduce operative time.
Henry, Francis P.,Leckenby, Jonathan I.,Butler, Daniel P.,Grobbelaar, Adriaan O. Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.6
Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent. Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon. Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05). Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.
Francis P Henry,Jonathan I Leckenby,Daniel P Butler,,Adriaan O Grobbelaar 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.6
Background: The aim of this study was to review the recipient vessels used in our cases offacial reanimation with free functional muscle transfer and to identify patient variables thatmay predict when the facial vessels are absent. From this we present a protocol for vesselselection in cases when the facial artery and/or vein are absent. Methods: Patients were identified from November 2006 to October 2013. Data was collectedon patient demographics, facial palsy aetiology, history of previous facial surgery/trauma andflap/recipient vessels used. A standard operative approach was adopted and performed by asingle surgeon. Results: Eighty-seven eligible patients were identified for inclusion amongst which 98hemifaces were operated upon. The facial artery and vein were the most commonly usedrecipient vessels (90% and 83% of patients, respectively). Commonly used alternative vesselswere the transverse facial vein and superficial temporal artery. Those with congenital facialpalsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with ahistory of previous facial surgery or trauma were significantly more likely to have an absentfacial artery and vein (P<0.05). Conclusions: Our algorithm can help to guide vessel selection cases of facial reanimationwith free functional muscle transfer. Amongst patients with congenital facial palsy or inthose with a previous history of facial surgery or trauma, the facial vessels are more likely tobe absent and so the surgeon should then look towards the transverse facial vein andsuperficial temporal artery as alternative recipient structures.