A keystone solution for major head and neck reconstructions

2019 ◽  
Vol 2 (2) ◽  
pp. 79-83
Author(s):  
Felix Behan
Keyword(s):  
Head And Neck ◽  
The Elderly ◽  
Microvascular Surgery ◽  
Island Flap ◽  
Aesthetic Outcome ◽  
Vascular Impedance ◽  
Supplementary Video

This ‘How to do it’ lists a range of cases, demonstrated by supplementary video discussion, that explain the refinements of the keystone perforator island flap (KPIF) technique applied to specific sites of the head and neck, with a focus on the elderly. When the P A C E acronym is applied (pain-free, aesthetic outcome, minimal complications, economical) the KPIF technique is a respectable alternative to microvascular surgery, particularly in the elderly, with minimal returns to theatre for vascular impedance problems which are not infrequent in microvascular reconstructions.  

Use of the keystone island flap for advanced head and neck cancer in the elderly – a principle of amelioration

2010 ◽  
Vol 63 (5) ◽  
pp. 739-745 ◽  
Author(s):  
Felix Behan ◽  
Andrew Sizeland ◽  
Fraser Gilmour ◽  
Andrew Hui ◽  
Matthew Seel ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
The Elderly ◽  
Island Flap ◽  
Advanced Head

The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery

ORL ◽  
2019 ◽  
Vol 81 (5-6) ◽  
pp. 327-337 ◽  
Author(s):  
Tina Rauchenwald ◽  
Daniel Dejaco ◽  
Evi M. Morandi ◽  
Gabriel Djedovic ◽  
Dolores Wolfram ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Pectoralis Major ◽  
Head And Neck Surgery ◽  
Island Flap ◽  
Aesthetic Outcome ◽  
Harvesting Technique ◽  
Muscle Sparing ◽  
Short Scar

Patterns of Care and Survival of Cutaneous Angiosarcoma of the Head and Neck

2020 ◽  
Vol 162 (6) ◽  
pp. 881-887 ◽  
Author(s):  
Clifford Chang ◽  
S. Peter Wu ◽  
Kenneth Hu ◽  
Zujun Li ◽  
David Schreiber ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Multimodality Treatment ◽  
The Elderly ◽  
Hazard Ratio ◽  
Patterns Of Care ◽  
Definitive Treatment ◽  
National Cancer Database ◽  
Curative Intent

Objective To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. Study Design Retrospective cohort study. Setting National Cancer Database. Methods The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. Results We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. Conclusion Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.

scholarly journals Imperceptible Scar over Face and Neck: A New Aesthetic Modification of Parotid Incision

2020 ◽  
Vol 28 (1) ◽  
pp. 44-50
Author(s):  
Gangadhara KS ◽  
Hamsa Shetty ◽  
Sridhara S
Keyword(s):  
Patient Satisfaction ◽  
Head And Neck ◽  
Aesthetic Outcome ◽  
Operative Complication ◽  
Aesthetic Appeal ◽  
Incision Site ◽  
Parotid Tumours ◽  
Total Parotidectomy ◽  
Scar Visibility

Introduction The mainstay of treatment for parotid tumours is surgery. Since the incision site involves visible areas of head and neck several modifications have evolved since its first description in 1912 by Blair and all the subsequent incisions have more or less aimed at giving better aesthesis in terms of post-operative facial scar. We describe a modification of earlier incisions for parotidectomy, which aims at camouflaging the post-operative facial and neck scar. Materials and Methods Fourteen patients were included in this study, who presented with parotid tumours and underwent either superficial or total parotidectomy. The modified incision was used in all the patients and various parameters were recorded (intra operatively as well as post operatively during the follow up visits, upto 1year) including post-operative scar visibility and patient satisfaction in terms of aesthetic appeal. Results All the 14 patients reported highly satisfied in terms of post-operative aesthetic outcome. There was no intra operative limitation of exposure by using this modified incision and neither any significant post-operative complication was encountered. Conclusion Our attempt at evolving an aesthetically modified incision for parotidectomy with no facial or neck scar post-operatively was achieved, along with certain more extended benefits of using this innovative incision.

scholarly journals Keystone perforator island flap: a clinical summary of 28 melanoma cases

2018 ◽  
Vol 1 (1) ◽  
pp. 101-106
Author(s):  
Felix Behan
Keyword(s):  
Vascular System ◽  
Lymphatic Drainage ◽  
Island Flap ◽  
Nerve Supply ◽  
Reactive Hyperaemia ◽  
Aesthetic Outcome ◽  
Simple Fact ◽  
Vascular Integrity ◽  
Plastic And Reconstructive Surgery ◽  
Regional Reconstruction

Background: The keystone perforator island flap (KPIF) and its design variations developed as a clinical necessity for reconstructing large surgical defects. This article focuses on melanoma management in 28 cases taken from a series of up to 3,000 established over 20+ years of clinical experience. Method: The dermatome is the basis of the keystone success where vessels accompany nerves. Keystone perforator island flaps are fascial lined, supporting vascular integrity. The design resembles two conjoined VY island flaps facilitating closure under tension as the perforator zones (perforazones) are oriented vertically with a stronger hydrostatic supply than the horizontally aligned subdermal plexus. Tissue match is important and contributes to a sound aesthetic outcome. Results: KPIF reconstructions are pain free even though tension is noted. KPIF reconstructions are almost anaesthetic for the complete dimension of the wound. This is explained by the simple fact that temporary interruption of somatic innervation in this design recovers over a few months in the same way as any longitudinal incision regains its nerve supply. Oedema in the KPIF is rarely observed and could possibly be a sympathetic affect. Reactive hyperaemia is evident in irradiated tissue, breaking another rule in plastic and reconstructive surgery in irradiated tissue where loco–regional reconstruction is contraindicated. Conclusion: With an intact vascular system associated with autonomic and somatic support—including lymphatic drainage, the Gillies principles of replacing ‘like for like’ and the ‘next best tissue is the next best tissue’—reconstructive design principles are maintained.

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