Single-stage maxillary and nasal floor reconstruction with the double-paddle rectus abdominis musculocutaneous free flap

Charles K. Herman, Teresa Benacquista, Nelya Brindzei, Max Berdichevsky, Thomas Baum, Berish Strauch

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Palatal integrity is essential for useful speech, deglutition, good oral hygiene, and prevention of nasal regurgitation. Maxillary defects after tumor extirpation, therefore, can have serious functional and cosmetic implications. Given the often disappointing results obtained with local and regional pedicled flaps for maxillary reconstruction, a variety of microvascular free flaps have been utilized in recent years, including the rectus abdominis, fibular, radial forearm, and latissimus dorsi flaps. Experience with these techniques has been documented in a limited number of case reports. We describe our single-stage approach to maxillary and nasal floor reconstruction with the double skin-paddle rectus abdominis musculocutaneous free flap. A series of five patients is presented; six of these immediate free flap reconstructions were performed for defects resulting from tumor resection. A vertical rectus abdominis musculocutaneous free flap was used in all cases, designing two separate skin paddles to accommodate the measured maxillary and nasal floor deficiencies. Anastomoses of the deep inferior epigastric artery and vena comitans were performed end-to-end to the facial artery and vein, respectively. In addition, orbital floor reconstruction with calvarial bone grafts or titanium mesh was performed in all five patients. Separation of the oral and nasal cavities was maintained postoperatively. No intraoperative complications, perioperative mortalities, flap losses, instances of skin paddle necrosis, hematomas, or oronasal fistulae were observed. One patient required bedside drainage of a surgical site abscess that resolved without adverse sequelae. Over the past 4 years, the double skin-paddle rectus abdominis musculocutaneous free flap has provided reliable results at our institution for single-stage reconstruction of maxillary and nasal floor defects. This reconstructive technique should be considered a viable method that can alleviate the functional and cosmetic debility associated with these defects.

Original languageEnglish (US)
Pages (from-to)131-135
Number of pages5
JournalJournal of Reconstructive Microsurgery
Volume23
Issue number3
DOIs
StatePublished - Apr 2007

Fingerprint

Rectus Abdominis
Myocutaneous Flap
Free Tissue Flaps
Nose
Skin
Cosmetics
Epigastric Arteries
Surgical Flaps
Superficial Back Muscles
Oral Hygiene
Nasal Cavity
Intraoperative Complications
Deglutition
Titanium
Forearm
Hematoma
Abscess
Fistula
Mouth
Drainage

Keywords

  • Double paddle
  • Maxillary reconstruction
  • Palatal reconstruction
  • Rectus abdominis free flap

ASJC Scopus subject areas

  • Surgery

Cite this

Single-stage maxillary and nasal floor reconstruction with the double-paddle rectus abdominis musculocutaneous free flap. / Herman, Charles K.; Benacquista, Teresa; Brindzei, Nelya; Berdichevsky, Max; Baum, Thomas; Strauch, Berish.

In: Journal of Reconstructive Microsurgery, Vol. 23, No. 3, 04.2007, p. 131-135.

Research output: Contribution to journalArticle

Herman, Charles K. ; Benacquista, Teresa ; Brindzei, Nelya ; Berdichevsky, Max ; Baum, Thomas ; Strauch, Berish. / Single-stage maxillary and nasal floor reconstruction with the double-paddle rectus abdominis musculocutaneous free flap. In: Journal of Reconstructive Microsurgery. 2007 ; Vol. 23, No. 3. pp. 131-135.
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