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Two cases of mandibular angle osseo-cutaneous reconstruction using composite scapula tip free flaps
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
tomy (CEA) offers an evidence based intervention for stroke risk reduction but its use for improving vascularity to free flaps has not been previously reported. The aim of this study was to assess the results of simultaneous CEA and jejunal free flap reconstruction in head and neck cancer patients with carotid artery disease. Method: Patients were identified who underwent a jejunal free flap and simultaneous CEA between 2006 and 2013 using a surgical database. A retrospective review of the notes was undertaken. A single surgeon carried out all flaps and CEA procedures. Results: 7 patients (mean 66.6 years) underwent simultaneous CEA and a jejunal flap. 5 CEA’s were unplanned and were carried out due to poor flow deemed insufficient to maintain the vascularity of the jejunum. In the remaining 2 patients CEA was undertaken based upon preoperative ultrasound findings. Post-operative complications were: stroke (3/7), flap failure (2/7) and death (3/7). Conclusions: CEA may be considered an option to improve blood flow to free flaps, although postoperative morbidity and mortality is high. Planned CEA appears to have fewer complications, and therefore Carotid Doppler studies are indicated in high-risk patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.084 P 77 Two cases of mandibular angle osseo-cutaneous reconstruction using composite scapula tip free flaps A. Pinto ∗ , E. Twohig, A. Schache, R. Shaw Aintree University Hospital, United Kingdom We present two cases requiring osseo-cutaneous reconstruction of the angle of the mandible that were reconstructed using a scapula tip free flap. These were the first two scapula tip flaps used within the Liverpool head and neck unit in over 500 cases of mandibular reconstruction. The first patient had a regional recurrence of a previously treated nasoethmoidal squamous cell carcinoma to the parotid lymph nodes and overlying skin. He required a prescription of post-operative radiotherapy that would also involve his previously irradiated mandible. The resection defect was successfully reconstructed using a chimeric scapula tip- thoracodorsal artery free flap. The second patient, who suffered from peripheral vascular disease required obliteration of an oro-cutaneous fistula that resulted due to the failure of two previous reconstruction, first with a fibula free flap followed by a pectoralis major flap overlying a reconstructive titanium plate. The fistula was successfully obliterated with a scapula tip- latissimus dorsi free flap. Both cases required a moderate amount of bone, a long pedicle length for anastomosis in the contralateral neck and a good volume of soft tissue to obliterate the cutaneous defects, all of which were provided by the above free flaps.
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We thus recommend the uses of this flap in selected cases. http://dx.doi.org/10.1016/j.bjoms.2015.08.085 P 78 The quality of patient information on the internet: the poorly advised patient A. Power ∗ , A. Gallagher, S. Betts York District Hospital, United Kingdom Symptomatic wisdom teeth are a common complaint and frequently cause patients to present to their GDP or maxillofacial unit. Although the majority of clinicians will be well rehearsed in providing information regarding the causes and treatments related to these conditions, patients are increasingly looking elsewhere for additional resources. The aim of this study was to evaluate the quality and reliability of websites providing patient health information, using the example of wisdom teeth and their treatment options. Method: An internet search was conducted to identify websites containing patient information on symptomatic wisdom teeth and treatment options. The first 100 results for each search term were examined. After removing discussion groups, news, video feeds, and duplicate sites, 34 relevant websites remained. The reliability and quality of these sites was assessed and a score assigned using the DISCERN instrument. Results: The maximum score attainable for a website was 80. Of the 34 websites that were scored, DISCERN indicated that the majority of websites fell well below this maximum, scoring an average of 41. There was however a wide variation in the scores obtained, with the highest scoring website achieving 74 and the lowest attaining a score of 16. Conclusion: Pathologies associated with wisdom teeth can have profound sequelae for our patients. Patients are increasingly using the internet to obtain health information. Clinicians should ensure that they are able to direct patients towards validated websites to ensure they access appropriate and accurate information. Further development of the information resources available at present is recommended. http://dx.doi.org/10.1016/j.bjoms.2015.08.086 P 79 Supraclavicular flaps in head and neck reconstruction – the Lancashire experience K. Rajaram ∗ , A. Wilson, S.G. Langton, K. McAlister, T. Blackburn, M. Maranzano Manchester Royal Infirmary, United Kingdom Free flaps have become the norm for complex reconstruction. However high risk patients with multiple co-morbidities may be rendered unsuitable for microvascular reconstruction
tomy (CEA) offers an evidence based intervention for stroke risk reduction but its use for improving vascularity to free flaps has not been previously reported. The aim of this study was to assess the results of simultaneous CEA and jejunal free flap reconstruction in head and neck cancer patients with carotid artery disease. Method: Patients were identified who underwent a jejunal free flap and simultaneous CEA between 2006 and 2013 using a surgical database. A retrospective review of the notes was undertaken. A single surgeon carried out all flaps and CEA procedures. Results: 7 patients (mean 66.6 years) underwent simultaneous CEA and a jejunal flap. 5 CEA’s were unplanned and were carried out due to poor flow deemed insufficient to maintain the vascularity of the jejunum. In the remaining 2 patients CEA was undertaken based upon preoperative ultrasound findings. Post-operative complications were: stroke (3/7), flap failure (2/7) and death (3/7). Conclusions: CEA may be considered an option to improve blood flow to free flaps, although postoperative morbidity and mortality is high. Planned CEA appears to have fewer complications, and therefore Carotid Doppler studies are indicated in high-risk patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.084 P 77 Two cases of mandibular angle osseo-cutaneous reconstruction using composite scapula tip free flaps A. Pinto ∗ , E. Twohig, A. Schache, R. Shaw Aintree University Hospital, United Kingdom We present two cases requiring osseo-cutaneous reconstruction of the angle of the mandible that were reconstructed using a scapula tip free flap. These were the first two scapula tip flaps used within the Liverpool head and neck unit in over 500 cases of mandibular reconstruction. The first patient had a regional recurrence of a previously treated nasoethmoidal squamous cell carcinoma to the parotid lymph nodes and overlying skin. He required a prescription of post-operative radiotherapy that would also involve his previously irradiated mandible. The resection defect was successfully reconstructed using a chimeric scapula tip- thoracodorsal artery free flap. The second patient, who suffered from peripheral vascular disease required obliteration of an oro-cutaneous fistula that resulted due to the failure of two previous reconstruction, first with a fibula free flap followed by a pectoralis major flap overlying a reconstructive titanium plate. The fistula was successfully obliterated with a scapula tip- latissimus dorsi free flap. Both cases required a moderate amount of bone, a long pedicle length for anastomosis in the contralateral neck and a good volume of soft tissue to obliterate the cutaneous defects, all of which were provided by the above free flaps.
e65
We thus recommend the uses of this flap in selected cases. http://dx.doi.org/10.1016/j.bjoms.2015.08.085 P 78 The quality of patient information on the internet: the poorly advised patient A. Power ∗ , A. Gallagher, S. Betts York District Hospital, United Kingdom Symptomatic wisdom teeth are a common complaint and frequently cause patients to present to their GDP or maxillofacial unit. Although the majority of clinicians will be well rehearsed in providing information regarding the causes and treatments related to these conditions, patients are increasingly looking elsewhere for additional resources. The aim of this study was to evaluate the quality and reliability of websites providing patient health information, using the example of wisdom teeth and their treatment options. Method: An internet search was conducted to identify websites containing patient information on symptomatic wisdom teeth and treatment options. The first 100 results for each search term were examined. After removing discussion groups, news, video feeds, and duplicate sites, 34 relevant websites remained. The reliability and quality of these sites was assessed and a score assigned using the DISCERN instrument. Results: The maximum score attainable for a website was 80. Of the 34 websites that were scored, DISCERN indicated that the majority of websites fell well below this maximum, scoring an average of 41. There was however a wide variation in the scores obtained, with the highest scoring website achieving 74 and the lowest attaining a score of 16. Conclusion: Pathologies associated with wisdom teeth can have profound sequelae for our patients. Patients are increasingly using the internet to obtain health information. Clinicians should ensure that they are able to direct patients towards validated websites to ensure they access appropriate and accurate information. Further development of the information resources available at present is recommended. http://dx.doi.org/10.1016/j.bjoms.2015.08.086 P 79 Supraclavicular flaps in head and neck reconstruction – the Lancashire experience K. Rajaram ∗ , A. Wilson, S.G. Langton, K. McAlister, T. Blackburn, M. Maranzano Manchester Royal Infirmary, United Kingdom Free flaps have become the norm for complex reconstruction. However high risk patients with multiple co-morbidities may be rendered unsuitable for microvascular reconstruction