Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors\' experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients\' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

OBJECTIVE: Durable and resilient soft tissue reconstruction of vast defects of the extremities or the torso.
METHODS: Reconstruction of disproportionately large defects, particularly in cases of simultaneous bone and joint reconstruction.
METHODS: History of surgery or irradiation of upper back and axilla, impossibility of surgery under lateral positioning; relative contraindications in wheelchair users, hemiplegics, or amputees.
METHODS: General anesthesia and lateral positioning. First, the parascapular flap is harvested, with the initial skin incision made medially in order to identify the medial triangular space and the circumflex scapular artery. Flap raising then proceeds from caudal to cranial. Second, the latissimus dorsi is harvested, with the lateral border being dissected free first, before the thoracodorsal vessels are visualized on its undersurface. Flap raising then proceeds from caudal to cranial. Third, the parascapular flap is advanced through the medial triangular space. If the circumflex scapular and thoracodorsal vessels originate separately from the subscapular axis, an in-flap anastomosis is warranted. Subsequent microvascular anastomoses should be performed outside the zone of injury, typically in an end-to-end fashion of the vein and end-to-side fashion of the artery.
METHODS: Postoperative anticoagulation with low-molecular-weight heparin under anti-Xa monitoring (semitherapeutic in normal-risk and therapeutic in high-risk cases). Hourly clinical assessment of flap perfusion for 5 consecutive days, followed by stepwise relaxation of immobilization and commencement of dangling procedures in cases of lower extremity reconstruction.
RESULTS: Between 2013 and 2018, 74 conjoined latissimus dorsi and parascapular flaps were transplanted to cover vast defects of the lower (n = 66) and upper extremity (n = 8). The mean defect size was 723 ± 482 cm2 and the mean flap size was 635 ± 203 cm2. Eight flaps required in-flap anastomoses for separate vascular origins. There was no case of total flap loss.
UNASSIGNED: OPERATIONSZIEL: Stabile und belastbare Weichteilrekonstruktion großflächiger Defekte der Extremitäten oder des Rumpfes.
UNASSIGNED: Rekonstruktion überdurchschnittlich großer Defekte, insbesondere bei Notwendigkeit simultaner Knocheneingriffe/Osteosynthesen.
UNASSIGNED: Voroperation oder Bestrahlung von Rücken/Axilla, Unmöglichkeit der Operation in Seitenlage; relative Kontraindikation bei Rollstuhlfahrern, Hemiplegikern, oder Amputierten.
UNASSIGNED: Operation in Allgemeinnarkose und Seitlagerung. Im ersten Schritt wird die Paraskapular-Lappenplastik präpariert, wobei wir die initiale Inzision medial vornehmen, um die mediale Achsellücke und A. circumflexa scapulae zu identifizieren, bevor die Lappenplastik von kaudal nach kranial gehoben wird. Im zweiten Schritt wird die Latissimus dorsi-Lappenplastik präpariert, wobei wir zunächst den Vorderrand des Muskels darstellen, um im Anschluss die thorakodorsale Gefäßachse auf der Unterseite aufzusuchen, bevor wir die Lappenplastik von kaudal nach kranial heben. Abschließend wird der Paraskapularlappen durch die mediale Achsellücke gezogen. Im Idealfall entspringen beide Stielgefäße der A. subscapularis, andernfalls muss eine „In-flap-Anastomose“ durchgeführt werden. Der mikrochirurgische Gefäßanschluss sollte wenn möglich außerhalb der Traumazone erfolgen, venös in End-zu-End- und arteriell in End-zu-Seit-Technik.
UNASSIGNED: Postoperative Antikoagulation mit niedermolekularem Heparin unter Anti-Xa-Kontrollen (semitherapeutisch bei normalem, therapeutisch bei hohem Risiko). Stündliche klinische Perfusionskontrollen für 5 Tage, erst dann Lockerung der strikten Bettruhe und Beginn des „Lappentrainings“ im Falle der Rekonstruktion unterer Extremitäten.
UNASSIGNED: Zwischen 2013 und 2018 wurden 74 kombinierte Musculus-latissimus-dorsi-Paraskapular-Lappenplastiken zur Rekonstruktion ausgedehnter Defekte der unteren (n = 66) und oberen Extremität (n = 8) transplantiert. Die mittlere Defektgröße betrug 723 ± 482 cm2, die mittlere kombinierte Lappengröße 635 ± 203 cm2. Acht Lappenplastiken zeigten keinen gemeinsamen Gefäßstiel. Es ereignete sich kein einziger vollständiger Lappenverlust.

OBJECTIVE: The contour defect resulting after parotidectomy can be cosmetically unappealing. Multiple reconstructive efforts have been reported to mitigate this problem. We describe a novel technique of vascularized parascapular fat reconstruction based on the circumflex scapular vessels and evaluate its outcomes.
METHODS: Consecutive patients who underwent parotidectomy with or without additional resections and vascularized parascapular fat flap reconstruction in 2020 were included. Demographic, morphologic, intraoperative, and postoperative data were assessed.
RESULTS: Eight patients (3 female) were included. Median cut-to-close time was 247 (range 209-298) minutes, including tumor ablation. None of the patients had any wound complications, and all except one was discharged on postoperative day 1. Flap monitoring was not performed. None reported any significant donor site morbidity except scar formation. At last follow up, all patients reported satisfactory facial contour.
CONCLUSIONS: Vascularized parascapular fat flap reconstruction of parotidectomy contour defects has satisfactory cosmetic outcomes with minimal morbidity and short hospitalization courses.

To demonstrate the application and surgical time savings of the Spider Limb Positioner for subscapular system free flaps in head and neck reconstructive surgery.
Single institution retrospective chart review and analysis of patients between 2011 and 2019 that underwent a subscapular system free flap either with or without use of the Spider Limb Positioner. One hundred five patients in total were reviewed with 53 patients in the Spider group. The surgical times were compared between the two groups. Patient-specific information regarding average age, laterality of donor site, recipient site, gender, and flap type were reviewed.
Forty-one patients in both groups underwent a latissimus free flap. Twelve of 53 in the Spider group and 11/52 in the control group underwent a scapula free flap. The average age in the Spider group at the time of surgery was 64 years. The recipient sites for the Spider groups were reviewed. The free flap was ipsilateral to the defect in 81% of cases. The mean surgical time for the 105 patients without the Spider was 568 minutes versus 486 minutes with a Spider P-value of .003478.
Use of the Spider Limb Positioner allows for a simultaneous two-team approach during free flap elevation of the subscapular system, which eliminates both dependence on an assistant to support the arm and time consuming positioning changes during flap elevation.
3 Laryngoscope, 131:525-528, 2021.

The present article focuses on a relatively rare condition of a partial necrosis of free microvascular flap in a patient with severe postburn contracture of the neck region, subjected to reconstructive microsurgery. Reconstructive microsurgical staged procedure was undertaken to correct the scar contracture and restore the aesthetic unit. Substantial partial flap necrosis, requiring secondary surgery, was observed in the early postoperative period. Surprisingly only the distal 1/3 of the skin island of the parascapular flap survived. Final reconstruction of the neck reconstruction was accomplished by means of full thickness skin graft over the area of partially necrotic flap. Good final result was achieved. Overall treatment course is discussed in the light of the current trends.

Reconstruction of posterior thoracic and trunk defects can prove challenging even to the most seasoned surgeons. Many commonly used techniques for closing back defects include primary closure and split skin grafts. Often times, however, other techniques are needed in order to give the patient the best aesthetic and functional outcome. In this study, we focus on and evaluate donor site closure techniques for defects in the back created by harvesting scapular and parascapular flaps.
Twenty patients were operated on to remove pathologically diagnosed sarcomas using a wide local excision. The defects, ranging from 5 to 22 cm in width, were closed using donor flaps from the scapular/parascapular region. Nine donor sites were then closed primarily with wide undermining, while 11 donor sites were closed using multiple techniques, such as large transposition flaps, large rotation advancement flaps, keystone neurovascular island flaps, latissimus dorsi advancement flap and large Y-V advancement flaps.
All recipient and donor flaps survived with good aesthetic and functional outcome. Patient satisfaction was high and only two of 20 donor site flaps required further surgery due to wound dehiscence. No other complications were seen during the follow-up period.
The proposed advanced techniques for donor site closure in back defects have shown that primary wound healing can be achieved with the use of a variety of different techniques and the avoidance of the complications of a skin graft.