Purpose: The supraclavicular artery island (SAI) flap is commonly used in the reconstruction of head and neck defects. However, the safety of SAI flaps for neck irradiated patient needs to be verified. To investigate the safety of using the SAI flap for patients who have undergone neck radiotherapy, as well as the risk factors for flap complications. Materials and Methods: Sixty-one patients (16 irradiated and 45 nonirradiated) with SAI flap-reconstructed head and neck defects were included, and relevant data were collected retrospectively. The gender, age, body mass index, presence of diabetes mellitus, preoperative albumin level, and flap size between irradiated and nonirradiated patients had no significant difference. Results: No significant difference was observed in the incidence of complications (total, mild, or severe) between the radiotherapy and nonradiotherapy groups. In univariate analysis, preoperative radiotherapy was not associated with postoperative complications of the SAI flap procedure (P = 1.00), while a low preoperative albumin level was a significant risk factor for postoperative complications (P < .05). Conclusions: Our data suggest that preoperative radiotherapy does not increase the risk of SAI flap postoperative complications compared with surgical reconstruction alone.

OBJECTIVE: Nutritional and inflammatory statuses have been associated with complications in microvascular-free flaps during head and neck surgeries. This study aimed to evaluate the potential of nutritional indicators in predicting postoperative free flap complications.
METHODS: We conducted a 20-year retrospective, case-control study within a defined cohort.
METHODS: The study involved head and neck cancer patients from the Chang Gung Research Database who underwent simultaneous tumor ablation and free flap wound reconstruction between January 1, 2001, and December 31, 2019.
METHODS: We employed logistic regression and stratified analysis to assess the risk of free flap complications and the subsequent need for flap revision or redo in relation to nutritional indicators and other clinical variables.
RESULTS: Of the 8066 patients analyzed, 687 (8.5%) experienced free flap complications. Among these, 197 (2.4%) had free flap failures necessitating a redo of either a free flap or a pedicled flap. Beyond comorbidities such as chronic obstructive pulmonary disease, end-stage renal disease, and a history of prior radiotherapy, every 10-unit decrease in the preoperative prognostic nutritional index (PNI) was consistently associated with an increased risk of both free flap complications and failure. The covariate-adjusted odds ratios were 1.90 (95% confidence interval [CI]: 1.42-2.54) and 1.89 (95% CI: 1.13-3.17), respectively.
CONCLUSIONS: A lower preoperative PNI suggests a higher likelihood of microvascular free flap complications in head and neck surgeries. Further randomized controlled trial designs are required to establish causality.

OBJECTIVE: The Lateral Arm Free Flap (LAFF) offers advantageous features like variable thickness and minimal hair growth. LAFF is primarily used in orofacial and pharyngeal reconstructions, with limited reports on tracheal/esophageal applications. Also, the psychological prognosis and quality of life in patients with LAFF reconstruction are lacking.
METHODS: This retrospective case series presents outcomes of LAFF reconstruction for head and neck surgical defects which included 19 patients. The disease type, location of reconstruction, TNM staging, tumor size, chemoradiation status, anxiety, depression, quality of life and detailed perioperative information of the LAFF reconstruction surgery were presented in a descriptive pattern. Subgroup analysis was conducted using Mann-Whitney U and Pearson r test.
RESULTS: All 19 patients (100%) had a viable flap after surgery with 5 (26.3%) of them developed flap-related complication. Patients with oropharyngeal reconstruction were more likely to have lower anxiety and depression score and higher quality of life than those with below-oropharyngeal reconstruction. However, no significant p-value was generated in any subgroup comparison or correlation test. And the application of LAFF in esophageal and tracheal reconstruction was proved to be successful.
CONCLUSIONS: The lateral arm free flap exhibits remarkable versatility and multifunctionality, providing advantageous outcomes in head and neck reconstruction.
METHODS: Level 4 according to OCEBM.

Objective:To study the anatomical characteristics of thoracoacromial artery perforator flap（TAAP）, and to explore the advantages and disadvantages of TAAP in head and neck reconstruction. Methods: Four fresh cadavers （8 hemichests） were collected for anatomical observation, the blood supply of chest skin was observed through autopsy, the presence, number, location, caliber, and landmark on the chest surface of all thoracoacromial artery perforators per hemichest were recorded, including the distance of each from the midpoint of the clavicle. The diameters of the thoracoacromial artery and perforating vessels were measured with vernier calipers （accuracy 0.05 mm）, the pedicle length and thickness were measured with a cm scale （accuracy: 1 mm） after the flap was obtained, and the retained photos were recorded. Results:No perforating branch （12.5%） was found on one side of the 8 hemichests, two perforating branches （12.5%） were found on one hemichest, and one perforating branches （75.0%） were found on the rest of the hemichests. The perforating point was about between the clavicular head of pectoralis major （clavicular part） and the sternocostal head （sternocostal part）. The vessels at the beginning of perforation were generally bulky, with an average diameter of 2.25 mm, however, the vessel diameter was significantly reduced after the perforation of the flap. The pedicle length of thoracoacromial artery perforator flap ranged from 5.43 cm to 9.03 cm, with an average length of 7.14 cm. The pedicle length from the exit point of perforator muscle gap to the flap was 2.32-4.63 cm, with an average length of 3.28 cm. The distance between the exit point of perforator muscle space and the lower edge of the midpoint of the clavicle was 3.31-4.52 cm, with an average distance of 3.77 cm. Conclusion:The thoracoacromial artery perforator flap has some advantages such as similar color as head, neck and maxillofacial region, stable blood supply, relatively consistent vascular pedicle length and caliber size, relatively larger flap, less damage to pectoralis major muscle, and protection of chest shape, thoracic movement and shoulder joint movement function. Although the clinical application of this flap is limited by the uncertainty of perforating vessels, postoperative asymmetry of the nipple and residual chest scar, it still has a broad application prospect in head and neck reconstruction.
目的：研究胸肩峰动脉穿支皮瓣（TAAP）的解剖学特点，并探讨TAAP在头颈部重建中的优缺点。 方法：取4具8侧新鲜尸体胸部标本用于解剖观测，观察胸部皮肤的血供情况，解剖观察穿支数量、位置以及类型。用游标卡尺（精确度0.05 mm）测量胸肩峰动脉及穿支血管的口径，且在获取皮瓣后用厘米刻度尺（精确度1 mm）测量血管蒂长度及厚度，并记录留存照片。 结果：8侧半胸中仅一侧未发现穿支（12.5%），一侧发现两支穿支（12.5%），其余均为一支穿支（75.0%），穿出点约在胸大肌锁骨头（锁骨部）和胸肋头（胸肋部）肌间隙之间。穿支起始处一般血管较为粗大，平均直径为2.25 mm，但穿入皮瓣后血管直径缩小较为明显。胸肩峰动脉穿支血管蒂总长5.43~9.03 cm，平均7.14 cm；穿支肌间隙穿出点至穿支入皮点的蒂长2.32~4.63 cm，平均3.28 cm；穿支肌间隙穿出点至锁骨中点下缘的距离为3.31~4.52 cm，平均3.77 cm。 结论：TAAP色泽与头颈部及颌面部相似，具有血供稳定、较为一致的血管蒂长度和口径大小，皮瓣相对较大，对胸大肌的破坏较小，并可保护胸部外形、胸廓运动和肩关节的运动功能。虽然TAAP穿支血管的不确定性以及术后造成的乳头不对称和胸部瘢痕残留在一定程度上限制了此皮瓣的临床应用，但在头颈部重建中仍具有广阔的应用前景。.

A retrospective cohort study of 253 radial forearm free flap (RFFF) procedures in head and neck reconstruction performed in our department between 2005 and 2018 was reviewed. In order to explore the effects between single and dual anastomoses, we applied Fisher\'s exact test for statistical analysis. Although no flap failure was identified, more venous compromises were observed in single anastomosis group (5/80 vs. 1/173). We conclude that dual venous anastomoses can reduce venous compromise resulted from unexpected causes in RFFF transfer. Therefore, we especially recommend dual venous anastomoses for those who cannot withstand a second surgery.

Profunda femoris artery perforator flaps (PAPFs) have not been widely used in head and neck reconstructions. The feasibility and outcomes of PAPFs for various head and neck reconstructions need to be investigated.
Retrospective analysis.
A single-institution review.
PAPFs were utilized in head and neck reconstructions from 2019 to 2021. Local anatomy, surgical technique, and complications were discussed. Chimeric PAPF applications with muscle components were described for coverage of extensive multiunit defects. Additionally, aesthetic and functional outcomes were compared with anterolateral thigh perforator flaps.
A total of 33 cases were included. The average age was 54.2 years (range, 30-74). The most common underlying pathology was oral squamous cell carcinoma (n = 26, 78.8%), while the mean ± SD body mass index was 25.4 ± 2.8 kg/m2 . Middle perforators (n = 14, 42.4%) were the most commonly utilized ones. The perforator-based chimeric/composite applications were used in 9 (27.3%), with the muscular components consisting of gracilis (n = 3, 9.1%), adductor magnus (n = 5, 15.2%), or semimembranosus muscles (n = 1, 3.0%). Venous thromboses of the PAPFs were found in 2 (6.1%), though salvaged. The occurrence of postoperative 90-day morbidity (complication) was related to mandibulectomy/maxillectomy (P = .020). Postoperative validated questionnaires showed a trend of intermediate to high scores, indicating noninferior outcomes in several categories, when compared with the anterolateral thigh perforator flap counterparts.
PAPFs are a good reconstructive alternative for intermediate to large head and neck reconstructions. Besides, PAPFs can provide sufficient tissue volume and versatility of potentially incorporating adjacent muscle components.

Segmental mandibular defects require reconstruction. The fibula flap serves as a versatile flap in restoring mandibular contour and bony height. With the advances in computer-aided design and additive manufacturing technology, an innovative \"one-piece\" patient-specific reconstruction plate to facilitate double-barrel fibula flap shaping and bone securing was developed; the plate is described in this study. The \"one-piece\" plate is fabricated with individualized specifications and is mainly composed of three components: the long-bar reconstruction plate, a short-bar plate, and connecting bars. Our initial experiences showed that mandibular reconstructive surgery was greatly facilitated by the \"one-piece\" reconstruction plate for double-barrel fibula flap reconstruction and achieved satisfactory outcomes. A well-designed clinical trial is required to confirm the superiority of the \"one-piece\" reconstruction plate in the future. ClinicalTrials.gov registration: NCT03057223.

Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: \"negative pressure wound therapy,\" \"head and neck,\" and \"fistula.\" We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow-up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of -125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high-quality trials are warranted to corroborate the findings of this systematic review.

Three-dimensionally (3D) printed patient-specific surgical plates have been proposed to facilitate mandibular reconstruction and are attracting extensive attention. We have recently reported the high accuracy of 3D-printed patient-specific surgical plates used in head and neck reconstruction. Based on this previous work, the current study proposes a novel \'surgeon-dominated\' approach to the design of 3D-printed patient-specific surgical plates. The aim of this proof-of-concept study was to explore the workflow and technical procedures of the surgeon-dominated approach. The workflow includes virtual surgery, the design and printing of patient-specific surgical devices, and real surgery. The prototype of the patient-specific surgical plate was designed by surgeons and further optimized for 3D printing by engineers. Different types of mandibular defect were tested to confirm the wide applicability of this approach. Cases in which this approach was used were reviewed and the duration of time spent on each case studied. Based on a total of 16 patients, the time spent on virtual surgery and plate design was 18.83±13.19hours, and the time taken for 3D printing, post-processing, and product delivery was 162.9±55.15hours. Therefore, this novel surgeon-dominated approach is feasible and time-saving, which would likely promote the wide application of patient-specific surgical plates and lead to a new era of \'digitization and precision\' in mandibular reconstruction. ClinicalTrials.gov registration: NCT03057223.

OBJECTIVE: To assess the efficacy and clinical application of a supraclavicular flap for head and neck reconstruction.
METHODS: A pedicled supraclavicular flap was used on 26 patients at Sun Yat-Sen University Cancer Center between July 2017 and November 2018, including 16 cases with oral cancer defects, 7 cases with laryngeal cancer and hypopharyngeal carcinoma defects, 1 case with parotid gland cancer defects, 1 case with external auditory canal cancer defects, and 1 case with tracheal esophageal fistula. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap, and the healing observed at the donor site are reported.
RESULTS: The sizes of the flaps were 6-20 × 4-6.5 cm. The time required to harvest the supraclavicular flap ranged from 25 to 35 min and averaged 30 min. The amount of intraoperative blood loss ranged from 20 to 100 ml and averaged 58.8 ml. The duration of postoperative drainage tube placement ranged from 3 to 8 days and averaged 5.9 days. A total of 23 flaps survived. In two cases, the distal blood supply of the flaps was poor, but the flaps survived after debridement and suturing. One flap had partial necrosis, but survived after conservative treatment. All donor area defects were directly sewed and stitched without complications.
CONCLUSIONS: There are multiple advantages of the supraclavicular flap, including simple preparation technique, reliable repair of the defects, and without the need for performing microvascular anastomosis. It can be safely used in head and neck reconstruction after surgery.