Search Results (10)

Background/Objectives: In recent decades, free flaps have emerged as the gold standard for head and neck reconstruction. However, their use is contraindicated in some cases due to advanced age and/or comorbidities. In such patients, a pedicled flap may be considered. The aim of this observational study was to evaluate strategies for head and neck reconstruction using pedicled flaps in the era of free flaps. Furthermore, the complication rate was analyzed. Methods: Patients who underwent head and neck reconstruction with pedicled flaps were included. The following flaps were considered: the pectoralis major (PMF), deltopectoral, platysma, frontal, temporal, nasolabial, supraclavicular artery island (SCAIF), infrahyoid, sternocleidomastoid, buccal fat pad, and facial artery myomucosal flap (FAMM). Patients’ characteristics, flap type, recipient sites, and flap-related complications were systematically recorded. Results: A total of 112 pedicled flaps were analyzed. A PMF was most commonly used for tongue and hypopharyngeal reconstruction. Partial and complete flap necrosis occurred in 11.6% and 1.8% of cases, respectively. Wound dehiscence was reported in 12.5% of cases, while pharyngo-/oro-cutaneous fistulas developed in 6.3% of patients. Hemorrhage from the donor site or flap occurred in 3.6% of cases, and pharyngeal stenosis in 0.9%. Conclusions: Each reconstructive strategy depends on the site and extent of tissue loss. Given the low complication rates, pedicled flaps remain a valid option for head and neck reconstruction in selected patients. Full article

Background/Objectives: Oral cavity defects highlight the necessity for individualized reconstructive strategies given their anatomical and functional complexity. Reconstructive surgery should optimize healing and function, minimize complications, and reduce operative time and costs. Although free flaps remain the gold standard for oral cavity reconstruction, they require large teams, specialized microsurgical equipment, and extended operative times. Methods: A retrospective analysis was performed on 59 consecutive patients who underwent intraoral reconstruction for medium-sized oral cavity defects between 2022 and 2025, using either a facial artery musculomucosal (FAMM) flap or a free flap. Statistical comparisons were made for excision parameters, operative variables, length of hospitalization, and postoperative outcomes. Results: Comparison between the FAMM and free flap reconstruction groups revealed no significant differences in patient age, gender, histopathological diagnosis, lesion size, oncological radicality, or functional outcomes related to speech and alimentation. However, FAMM flap reconstruction was associated with significantly reduced operative time (196.7 ± 94.9 min vs. 427.1 ± 129.8 min; p < 0.001), representing a 54% reduction in procedure duration. Similarly, the mean hospital stay was 40% shorter in the FAMM group (12.7 ± 6.0 days vs. 21.1 ± 8.0 days; p < 0.001). Intensive care unit admission was also markedly less frequent following FAMM flap reconstruction (7.3% vs. 83.3%; p < 0.001). Conclusions: In cases of small and medium-sized oral cavity defects, reconstruction using FAMM flaps represents a favorable alternative to free flap reconstruction, offering comparable functional outcomes while significantly reducing operative time and length of hospitalization. Full article

Background: Reconstruction of oral cavity defects following oncologic surgery presents both functional and esthetic challenges. While microvascular free flaps remain the gold standard for large defects, local flaps based on facial vessels offer effective solutions for small-to-medium-sized reconstructions. This narrative review evaluates the clinical utility of three commonly used facial vessel-based flaps: facial artery musculomucosal, submental, and nasolabial flaps. Methods: A literature search was conducted using PubMed, targeting studies from 1981 to 2025 that described the anatomical basis, harvesting techniques, modifications, indications, advantages, disadvantages, complications, limitations, and outcomes of these flaps. A total of 73 full-text articles were included based on predefined inclusion criteria. Results: The FAMM flap provides versatile intraoral coverage with low donor site morbidity. The submental flap is effective in select patients, particularly those unfit for microvascular surgery, though its oncologic safety in neck-positive cases is limited. The nasolabial flap offers good esthetic and functional results with minimal external scarring. Each flap presents unique attributes regarding reach, vascularity, and complication profiles. Conclusions: Facial vessel-based flaps are viable and effective options for oral cavity reconstruction in appropriate clinical scenarios. Thorough knowledge of flap anatomy, indications, and oncologic considerations is essential for optimal outcomes. Full article

Background/Objectives: Currently, there is a lack of a comprehensive classification system for soft-palate defects that provides synthetic information to guide functional reconstructive treatment. Our awareness, shaped by extensive experience, of the superiority of myomucosal flaps to fasciocutaneous flaps in functional palate reconstruction has driven us to introduce a new defect-based classification system and propose a new algorithm for reconstructing soft-palate defects using buccinator myomucosal flaps. Methods: Soft-palate defects were classified into five classes. A reconstruction algorithm employing buccinator myomucosal flaps—including axial, island, and tunnelized flaps along with their variants as described in previous studies—was utilized. Clinical records, including tumor stage, location, defect size, and details of the myomucosal flap used, were documented. Postoperative speech intelligibility, swallowing, and quality of life (QoL) were evaluated. Donor-site morbidity and complications were also assessed. Spearman’s rank correlation was employed to assess relationships between clinical parameters and functional outcomes. Results: Twenty-two patients who had undergone soft-palate resection and subsequent reconstruction were reviewed. Favorable recovery of swallowing and speech was reported in all cases, with a median deglutition score of 6.04 ± 0.85 and no severe velopharyngeal insufficiency observed (speech score: 0.36 ± 0.58). Quality of life assessments indicated satisfactory recovery across physical, social, emotional, and functional parameters. Donor-site morbidity was low (average score: 8.3), with only minor complications observed. Tumor stage showed a significant correlation with speech score (r = 0.44, p = 0.04). Conclusions: The proposed classification introduces a comprehensive, simple, and user-friendly categorization of soft-palate defects, accompanied by a myomucosal reconstructive algorithm designed to guide surgeons through the reconstructive process, aiming to provide optimal functional reconstruction. The study’s small sample size and monocentric design may have limited the detection of meaningful correlations, highlighting the need for larger, multicentric studies with objective methods to validate findings. Full article

The objective of this study was to investigate the effectiveness of buccinator myomucosal island flaps for tongue reconstruction following malignant tumor resections. A retrospective study was performed on 52 patients who underwent tongue reconstructions with buccinator myomucosal island flaps between 2012 and 2020. We reviewed the flap type and size, harvesting time, recipient- and donor-site complications, postoperative oncologic outcomes, functional recovery and QoL assessment. All of the flaps were transposed successfully without any total flap loss. Neither in the primary site nor in the neck were cancer relapses observed. An evaluation of the sensitivity revealed that 96.1% of patients experienced a recovery of touch, two-point and pain sensations. There were significant differences between the flap and the native mucosa in terms of the tactile (p < 0.001), pain (p < 0.001) and two-point (p < 0.001) thresholds. The average swallowing score recorded was 6.1 out of 7, with only minor complaints. The quality of life assessments demonstrated high scores across physical (24.5 out of 28), social (25.8 out of 28), emotional (20.3 out of 24) and functional (25 out of 28) aspects. The present study showed how buccinator myomucosal island flaps represent an effective and functional tongue reconstructive option, requiring a short operative time with a low rate of donor site morbidity, and with evidence of long-term oncologic safety and high quality of life. Full article

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life. Full article

Backgroundand Objectives: The reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. The facial artery musculomucosal (FAMM) flap and the myomucosal buccinator flap (Bozola flap) are important tools in the reconstruction of intraoral defects. In this study, we describe the combination of both flaps—the extended, double-pedicled FAMM (dpFAMM) flap—and present clinical results of the reconstruction of moderate tongue defects in edentulous patients. Materials and Methods: a tongue defect, after squamous cell carcinoma excision, was reconstructed with the dpFAMM flap in 5 patients. Most of them received postoperative radiotherapy. Results: the healing process was uneventful in all patients. We did not observe flap necrosis or venous congestion. Tongue mobility, speech and swallowing were satisfactory. Conclusions: In conclusion, the dpFAMM flap is a good alternative in the reconstruction of moderate defects of the lateral part of the tongue. The flap is easy to harvest and has a good vascularity. This is a predictable method of reconstruction, especially for elderly patients with numerous comorbidities. Full article

The aim of this study was to estimate the overall viability of the islanded facial artery myomucosal flap (iFAMM) compared to the facial artery myomucosal flap (FAMM). A systematic review of English articles was performed on PubMed and Cochrane Library electronic databases. Search terms included every nomenclature variant for FAMM flap and iFAMM flap. A total of 373 articles were identified, and 20 articles were considered eligible for inclusion in the review. A total of 486 flaps were evaluated (350 FAMM and 136 i-FAMM flaps). In all studies, the primary outcome assessed was flap viability, collecting the rate of total and partial flap necrosis and then comparing FAMM to i-FAMM. Overall reported partial/total necrosis rate for FAMM flap was 9.7%, 1.4% as total and 8.3% as partial necrosis. Overall partial/total reported necrosis rate for iFAMM flaps was 2.2%, 1.5% as total and 0.7% as partial necrosis. FAMM flaps, both as classical or islanded variants, are an effective option for intraoral small/medium sized defect reconstruction. Outcomes from the present review show a higher partial/total survival rate when this flap is harvested as islanded flap. Full article

Reconstruction of floor of the mouth and ventral surface of the tongue defects can be challenging because inadequate correction can lead to mobility restriction of the tongue and resultant impairment of speech and swallowing. Ideal flap should be pliable, provide adequate bulk, be easy to harvest, and cosmetically acceptable. Commonly used ipsilateral facial artery–based myomucosal flaps may not be ideal if facial vessels need resection. We share our experience in a case of simultaneous primary mucoepidermoid carcinoma of right submandibular and sublingual glands, with a postsurgical defect involving floor of the mouth and ventral surface of the tongue, reconstructed with islanded facial artery myomucosal flap raised from left buccal mucosa and tunneled into the right floor of the mouth defect medial to mandible. The case is being reported to share the method of reconstruction as well as for the rare presentation of simultaneous primary mucoepidermoid carcinoma of multiple major salivary glands. Full article

Background: After cleft palate repair is performed, oronasal fistulas are potential consequences with resultant regurgitation of fluid and food, hearing loss, and velopharyngeal insufficiency. Treatment of oronasal fistulas is a challenge for plastic surgeons especially when the fistulas are large and scarring is significant. The facial artery musculomucosal (FAMM) flap, introduced by Pribaz in 1992, is a reliable and useful procedure for the closure of wide palatal fistulas. A new modification of facial artery composite flap is presented here including a skin component that avoids extended procedures for nasal layer reconstruction and reduces the mucosal component size. The flap described here is the nasal arterymusculomucosal (NAMMC) flap; the main blood supply comes from the lateral nasal artery, a terminal branch of facial artery. Methods: We present a series of anteriorly and posteriorly based NAMMC flaps, which were used to close large palatal fistulas after cleft palate repair in 12 patients. Results: All flaps were successful. One flap had an anterior wound dehiscence in a bilateral case, and we have seen no total flap failure or postoperative palatal fistulas. The aesthetic appearance of the skin donor site was acceptable in all cases. Conclusions: The NAMMC flap is a good alternative for closing wide and recurrent fistulas. It is associated with a high rate of success. The traditional FAMM flap should be named as “nasal (lateral) artery musculomucosal flap” because the distal branch of the facial artery is the main blood supply of the flap. Full article