The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or \"supercharge\" a large ALT to optimize skin perforator supply or lengthen the vascular pedicle.
We report a case of a 77-year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed.
We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction.
This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle.

Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction.
We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap.
There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.

BACKGROUND: Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.
METHODS: A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90.
CONCLUSIONS: We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.

Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous malignancy with a high rate of recurrence if the head-and-neck region is involved. Treatment is challenging as it is difficult to avoid poor aesthetic and functional outcomes using the standard approach of complete resection with negative margins and subsequent reconstruction. This is especially challenging in cases where the face is involved and the defect is large after resection. There have been few cases of reconstruction using different flaps reported. We present the case of a young lady with a large cheek tumor, which was reconstructed using an anterolateral thigh flap. Excellent functional and aesthetic outcomes were achieved.

Patients undergoing head and neck free flap reconstruction should be evaluated for radiation-induced venous stenosis and presence of central venous port as a potential risk for flap failure.

OBJECTIVE: After resection of malignancies of the jaws, CAD/CAM procedures have become standard for primary bony reconstruction. Even so, these techniques may limit surgical resection safety. Therefore, the aim of the study was to examine osseous as well as soft tissue resection margins after CAD/CAM-guided tumor resections and reconstructions.
METHODS: A retrospective analysis of patients treated with oral squamous cell carcinoma (OSCC) from 2014 to 2019 was performed. Inclusion criteria were CAD/CAM-guided osseous resection and primary reconstruction. Evaluation was performed for histological confirmed resection margins (hard and soft tissue) as well as recurrence of the disease related to the resection status.
RESULTS: In 46 patients, bony resection margins were classified: tumor free (R0 41/46), microscopical invasion (R1 1/46), and close margin (R0 < 4 mm 4/46) respectively for soft tissue 29/46 tumor free (R0), 7/46 close margin (R0 < 4 mm), 5/46 R1, and 4/46 could not be further determined (Rx). Fourteen patients (14/46) showed recurrent disease (2/46 locoregional) without association with the bony resection margin status. Recurrence occurred predominantly (13/46) in high-staged tumor patients. R1/close margin/Rx resection of the soft tissue resulted in a significant earlier recurrence when compared with R0 resection.
CONCLUSIONS: CAD/CAM procedure allows safe tumor resection with the profit of a guided and accurate reconstruction. In contrast to positive soft tissue margins, positive bony resection margins did not increase recurrence parameters.

BACKGROUND: The omental free flap is an effective tool for craniofacial reconstruction. However it is generally under-utilised by a large number of practitioners. This paper\'s goal is to increase awareness of this free flap\'s accessibility and to demonstrate that it can be an attractive option for reconstructive surgery.
METHODS: This article outlines the details of a 57-year-old patient who required coverage of a fronto-parietal wound with dura mater exposure. After previous failed conventional free flap attempts, a procedure using the omental free flap was finally performed on this severe wound. The omentum was harvested via a 8cm laparotomy and anastomosed to the temporal vessels. The final result was successful, with a favorable aesthetic result.
CONCLUSIONS: The omental free flap has many advantages: the pedicle length is long, it allows coverage of a large wound, it can be applied to a wound bed previously irradiated and infected, it has a low morbidity rate to the donor site, the surgical technique of harvesting is easy, the aesthetic result is satisfactory. However, the absence of skin slice is a disadvantage of the omental free flap because it makes monitoring difficult and it requires a skin graft in a second procedure. Laparoscopic harvest of omentum free flaps is a safe and effective tool in the reconstructive armamentarium. Every maxillofacial and plastic surgeon should aim to master and use this method as a legitimate option in some infrequent but appropriated cases.