Gido Bittermann1, Philipp Thönissen2, Philipp Poxleitner2, Ruediger Zimmerer3, Kirstin Vach4, Marc C Metzger2. 1. Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany. Electronic address: gido.bittermann@uniklinik-freiburg.de. 2. Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany. 3. Oral and Maxillofacial Surgery, University Hannover, Carl-Neubergstr. 1, D-30625 Hannover, Germany. 4. Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Abstract
BACKGROUND: Despite oversized latissimus dorsi free flap reconstruction in the head and neck area, esthetic and functional problems continue to exist due to the well-known occurrence of transplant shrinkage. The purpose of this study was to acquire an estimation of the volume and time of the shrinkage process. MATERIALS AND METHODS: The assessment of volume loss was performed using a 3D evaluation of two postoperative CT scans. A retrospective review was conducted on all latissimus dorsi free flap reconstructions performed between 2004 and 2013. Inclusion criteria for the assessment were: resection of an oral carcinoma and microsurgical defect coverage with latissimus dorsi free flap; a first postoperative CT (CT1) performed between 3 weeks and a maximum of 3 months after reconstruction surgery; and an additional CT scan (CT2) performed at least one year postoperatively. The exclusion criterion was surgical intervention in the local area between the acquisition of CT1 and CT2. The effect of adjuvant radiation therapy was considered. Volume determination of the transplant was carried out in CT1 and CT2 by manual segmentation of the graft. RESULTS: Fifteen patients were recruited. 3D evaluation showed an average volume loss of 34.4%. In the consideration of postoperative radiotherapy the volume reduction was 39.2% in patients with radiotherapy and 31.3% in patients without radiotherapy. CONCLUSION: The reconstruction flap volume required for overcorrection of the surgical defect was investigated. This study indicates that a volume loss of more than 30% could be expected one or more years after latissimus dorsi free flap reconstruction. Clinical trial number DRKS00007534.
BACKGROUND: Despite oversized latissimus dorsi free flap reconstruction in the head and neck area, esthetic and functional problems continue to exist due to the well-known occurrence of transplant shrinkage. The purpose of this study was to acquire an estimation of the volume and time of the shrinkage process. MATERIALS AND METHODS: The assessment of volume loss was performed using a 3D evaluation of two postoperative CT scans. A retrospective review was conducted on all latissimus dorsi free flap reconstructions performed between 2004 and 2013. Inclusion criteria for the assessment were: resection of an oral carcinoma and microsurgical defect coverage with latissimus dorsi free flap; a first postoperative CT (CT1) performed between 3 weeks and a maximum of 3 months after reconstruction surgery; and an additional CT scan (CT2) performed at least one year postoperatively. The exclusion criterion was surgical intervention in the local area between the acquisition of CT1 and CT2. The effect of adjuvant radiation therapy was considered. Volume determination of the transplant was carried out in CT1 and CT2 by manual segmentation of the graft. RESULTS: Fifteen patients were recruited. 3D evaluation showed an average volume loss of 34.4%. In the consideration of postoperative radiotherapy the volume reduction was 39.2% in patients with radiotherapy and 31.3% in patients without radiotherapy. CONCLUSION: The reconstruction flap volume required for overcorrection of the surgical defect was investigated. This study indicates that a volume loss of more than 30% could be expected one or more years after latissimus dorsi free flap reconstruction. Clinical trial number DRKS00007534.
Authors: Chang Min Kang; Jeong Su Shim; Sung Hwan Park; Young Ju Jeong; Ki Ho Seol; Sang Gyu Kwak Journal: Plast Reconstr Surg Glob Open Date: 2021-04-15