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LETTER TO THE EDITOR
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 149-150

“No touch” novel technique for positioning of free flap pedicle in head-and-neck onco-reconstructive surgeries


1 Department of Plastic Surgery, Fortis Hospital Mulund, Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Fortis Hospital Mulund, Mumbai, Maharashtra, India

Date of Submission02-Sep-2020
Date of Acceptance06-Oct-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Dr. Hitesh R Singhavi
1135, OPD B, Department of Surgical Oncology, Fortis Hospital Mulund, Mumbai. Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_94_20

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How to cite this article:
Prasad S, Heroor A, Bangera S, Jain K, Singhavi HR. “No touch” novel technique for positioning of free flap pedicle in head-and-neck onco-reconstructive surgeries. Turk J Plast Surg 2021;29:149-50

How to cite this URL:
Prasad S, Heroor A, Bangera S, Jain K, Singhavi HR. “No touch” novel technique for positioning of free flap pedicle in head-and-neck onco-reconstructive surgeries. Turk J Plast Surg [serial online] 2021 [cited 2021 Apr 23];29:149-50. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/2/149/312189




  Introduction Top


According to Globocan 2018, the annual incidence of lip, oral cavity, and pharyngeal cancers was 529,500 which is predicted to rise by 62% by 2035. These tumors are responsible for approximately 150,000 death, with 50% of it occurring in India.[1] Surgery is still the mainstay of the treatment in oral cavity cancers.[2],[3] Majority of all the advanced operable oral cavity cancers which undergo surgical excision require free flap reconstruction most commonly being radial free flap, anterolateral thigh flap, and free fibula.[4]

Challenge

One of the challenges faced during such a procedure is injury to the pedicle. Transfer of the pedicle from the oral cavity to the neck in the presence of intact mandible or floor of the mouth is a task. Generally, it is a blind procedure which raises the chances of being injured during the process, especially due to sharp bony edges postablative procedures.

Novel technique

This technique has its role in the transfer of pedicle to the recipient site after harvesting [Figure 1] and division of the flap pedicle. As the usual length of the pedicle (radial forearm free flap) is 15–18 cm in length and 3 mm in diameter,[5] segment of the suction tube is cut measuring about 15 cm. It is also 12 mm in diameter, wide enough to accommodate both cephalic vein and radial artery. Next, the floor of the mouth is pierced with a large hemostat. The cut suction tube is passed into this space and positioned near the recipient vessels [Figure 2]. The flap pedicle is placed into the tube, and low powered suction is applied to the other end [Figure 3]. Care is taken to avoid direct contact of the pedicle with a suction tip. The gentle suction acts as a traction of the pedicle within the tube as the entire unit is pulled into the neck without mechanically touching it, thus permitting an atraumatic passage of the pedicle [Figure 4]. The diameter (12 mm) of the tube ensures that the tunnel in the floor of the mouth is of adequate diameter. Once the pedicle is in the neck, light suction is turned off, and tube is removed [Figure 5]. Then, a microvascular clamp is applied to the pedicle tip to prevent displacement of the pedicle from the neck during the flap inset.
Figure 1: Insertion of the suction tube and feeding of the vessel in the suction tube

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Figure 2: Harvested radial forearm free flap

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Figure 3: Transfer of pedicle under the tunnel

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Figure 4: Active suction tube at the end of the pedicle

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Figure 5: Transfer of pedicle complete

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Advantage

  1. It is an atraumatic, simple, cost-effective procedure of transferring the pedicle into the neck
  2. This procedure creates enough space in the neck to prevent its compression preventing vascular insufficiency
  3. It does not require exclusive expertise and instrumentation.


Indication

  1. In the oral cavity resection procedure especially involving marginal mandibulectomy
  2. Buccal mucosa defect with intact mandible
  3. Small tongue defects such as hemiglossectomy (with less or no floor of the mouth defect).



  Conclusion Top


Usage of a suction tube not only provides structural protection but also facilitates atraumatic transfer of pedicle due to light suction. Thus, the use of “No Touch” atraumatic transfer of pedicle using suction tube can be used safely in the selected cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.  Back to cited text no. 1
    
2.
Nair D, Singhvi H, Mair M, Qayyumi B, Deshmukh A, Pantvaidya G, et al. Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India. Indian J Cancer 2017;54:616-20.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Shah JP, Gil Z. Current concepts in management of oral cancer Surgery. Oral Oncol 2009;45:394-401.  Back to cited text no. 3
    
4.
Almadori G, Rigante M, Bussu F, Parrilla C, Gallus R, Barone Adesi L, et al. Impact of microvascular free flap reconstruction in oral cavity cancer: Our experience in 130 cases. Acta Otorhinolaryngol Ital 2015;35:386-93.  Back to cited text no. 4
    
5.
Cha YH, Nam W, Cha IH, Kim HJ. Revisiting radial forearm free flap for successful venous drainage. Maxillofac Plast Reconstr Surg 2017;39:14.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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