Biomedical subjects

Peirong Yu

Publications and source records attributed to Peirong Yu.

15 recordsLinked to original sources

PubMed2006

Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap.

BACKGROUND: Preoperative localization of the cutaneous perforators is an important step in designing anterolateral thigh flaps. The purpose of this study was to examine the accuracy of two commonly used Doppler devices in locating these perforators. METHODS: This study was conducted in 100 free anterolateral thigh flaps during a 2-year period. Cutaneous perforators of the anterolateral thigh flaps were localized in the clinic using the Huntleigh Mini Dopplex D-900 unit with an 8-MHz probe (Huntleigh Diagnostics Ltd., Cardiff, United Kingdom) and in the operating room just before surgery using the Koven ES-100X Mini Doppler unit with a 10-MHz sterile probe (Koven Technology, Inc., St. Louis, Mo.). The locations of Doppler signals and of the actual cutaneous perforators at surgery were plotted and compared. RESULTS: One to three cutaneous perforators of the anterolateral thigh flap were consistently found at specific locations; they were named perforators A, B, and C from proximal to distal. Perforators A, B, and C were present in 51, 89, and 62 cases, respectively, at surgery and were approximately 5 cm apart. The sensitivities and specificities in detecting perforator B were 100 percent and 0 percent, respectively, for the Huntleigh Doppler unit, and 91 percent and 55 percent for the Koven unit. The Doppler signal was within 1 cm of the actual perforator B location in 74 percent and 70 percent of the flaps with the Huntleigh and Koven units, respectively. The accuracy of Doppler examination decreased as body mass index increased. CONCLUSIONS: Preoperative handheld Doppler examination is not always accurate and should be used with caution in flap design.

Adult↗

PubMed2006

Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction.

BACKGROUND: We examined speech and swallowing outcomes and complications in patients with anterolateral thigh (ALT) flap reconstruction of cervical esophageal defects. METHODS: We retrospectively reviewed 29 patients treated with laryngopharyngectomy and ALT flap reconstruction at The University of Texas M. D. Anderson Cancer Center from March 2002 to July 2004. We compared complication rates, nutritional intake, number of tracheoesophageal punctures (TEPs), speech fluency and use, operative defects, and radiotherapy effects. RESULTS: Twenty-two patients had circumferential defects, and seven had partial defects. Twenty-four patients had radiotherapy. Eleven patients underwent TEP. Higher complication rates in patients after TEP compared with those without TEP were not statistically significant (p = .268). Ninety percent of patients with TEP spoke fluently. Ninety percent of all patients returned to oral alimentation without significant effect from TEP (p = 1.00), complications (p = 1.00), radiation therapy (p = 1.00), or surgical defect (p = .56). CONCLUSIONS: The ALT flap successfully reconstructs laryngopharyngeal defects with excellent speech and swallowing results.

Adult↗

PubMed2006

Internal mammary artery perforator (IMAP) flap for tracheostoma reconstruction.

BACKGROUND: Tracheostoma reconstruction requires a thin flap to avoid occlusion. Although the deltopectoral flap has been used as a rotational flap for decades, clinical use of a true internal mammary artery perforator island flap has not been reported. METHODS: In two cases, tracheostoma and anterior neck reconstruction were performed by use of an internal mammary artery perforator flap as a pedicled island flap. One flap was based on the perforator vessels in the second intercostal space and, the other, on the third. Donor sites were closed primarily in both patients. RESULTS: The internal mammary artery perforator flaps were well perfused in both cases. Both flaps healed uneventfully, with reliable reconstruction of the tracheal stoma and coverage of the anterior neck, although overall prognoses were poor. CONCLUSION: The internal mammary artery perforator flap is a relatively thin and reliable flap for tracheostoma and lower neck reconstruction.

Aged↗

PubMed2006

Isolated cervical esophageal reconstruction for rare esophageal tumors.

BACKGROUND: Isolated defects in the cervical esophagus in patients who have not undergone total laryngectomy are uncommon. We report 2 cases of rare esophageal tumors requiring reconstruction of the cervical esophagus after tumor resection. METHODS AND RESULTS: The patients were a 51-year-old woman with an esophageal granular cell tumor and a 54-year-old woman with an esophageal schwannoma. Both defects were reconstructed with a radial forearm flap. A small subclinical leak developed in 1 patient and healed spontaneously within 2 weeks. At 1 year and 2 years of follow-up, both patients were consuming a normal diet and had normal voices. CONCLUSIONS: A thin and well-vascularized flap such as the radial forearm flap is essential for reconstructing an isolated cervical esophageal defect so as to maximize functional outcome.

Cervicoplasty↗

PubMed2006

Human tracheal reconstruction with a composite radial forearm free flap and prosthesis.

Reconstruction of large tracheal defects has been largely unsuccessful. We report a novel single-stage tracheal reconstruction for a 6.5-cm long defect involving the anterior two thirds of the tracheal circumference in a patient with deeply infiltrative thyroid cancer into the tracheal lumen. The reconstruction was completed using a conduit composed of a radial forearm free flap for lining with a combined PolyMax mesh (Synthes, Paoli, PA) and Hemashield vascular graft (Boston Scientific, Natick, MA) for rigid support. At a 6-month follow-up the patient has normal swallowing and preoperative voice quality, and she maintains a patent, non-stented airway.

Female↗

PubMed2006

Engineering a composite neotrachea in a rat model.

BACKGROUND: Attempts to reconstruct the trachea have been largely unsuccessful because of its rigidity and opening to the outside environment. Materials that impart rigidity are usually alloplastic, so they cannot be exposed to the open environment without an unacceptably high risk of infection and rejection. The authors hypothesized that tissue engineering principles can be employed to construct a well-integrated neotrachea with rigid support and an epithelial lining to mimic the structure and function of the native trachea. METHODS: A 30-mm-long segment of polytetrafluoroethylene vascular graft with a diameter of 10 mm was lined with a fascial flap based on the superficial inferior epigastric artery with full-thickness skin grafts on its luminal surface. The composite unit was then buried under the abdominal skin of 20 rats and harvested 3 weeks later. Microfil and methylene blue dye were injected into the superficial inferior epigastric arteries and histologic analyses were performed to assess microcirculation and polytetrafluoroethylene-tissue integration. RESULTS: Two composite neotracheas experienced minor damage due to chewing by the rats, but all other neotracheas were viable and without infection. Injection studies demonstrated excellent circulation throughout the fascial flaps and skin grafts and across the polytetrafluoroethylene grafts to the overlying abdominal skin. Histologic analyses revealed abundant muscle-walled blood vessel ingrowth within the polytetrafluoroethylene grafts and all layers of the neotracheas with minimal inflammatory reactions. CONCLUSION: The authors successfully have engineered a well-integrated neotrachea in rats that possesses rigid support, an epithelial lining, and reliable coverage-the prerequisites for successful trachea reconstruction.

Animals↗

PubMed2006

Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap.

BACKGROUND: Pharyngoesophageal defects are commonly reconstructed with free jejunal or fasciocutaneous flaps, with various outcomes, and a direct comparison is lacking. METHODS: Fifty-seven circumferential pharyngoesophageal reconstructions with an anterolateral thigh flap (n = 26 patients) performed by a single surgeon or jejunal flap (n = 31 patients) performed by six experienced surgeons between 1998 and 2004 were reviewed and outcomes were compared. RESULTS: Total flap loss occurred in one (4 percent) and two (6 percent) patients, fistula rates were 8 percent and 3 percent, and stricture rates were 15 percent and 19 percent in the anterolateral thigh and jejunal flap groups, respectively (p > 0.5). A completely oral diet was achieved in 95 percent and 65 percent, and fluent tracheoesophageal speech was achieved in 89 percent and 22 percent of patients with the anterolateral thigh and jejunal flaps, respectively (p < 0.01). The mean lengths of postoperative ventilator support, intensive care unit stay, and hospital stay were 1.0 +/- 0.2, 1.7 +/- 1.0, and 8.0 +/- 3.7 days for the anterolateral thigh flap group and 2.2 +/- 3.0, 3.0 +/- 3.2, and 12.6 +/- 7.9 days for the jejunal flap group (p < 0.001 for all), respectively. Mean hospital charges per patient were $8694 and $12,651 for the anterolateral thigh and jejunal flap groups, respectively (p = 0.02). CONCLUSIONS: With the limitations of comparing a single surgeon's results with those of multiple surgeons, the anterolateral thigh flap appears to offer better speech and swallowing functions and quicker recovery and to be more cost-effective than the jejunal flap for pharyngoesophageal reconstruction. The complication rates were similar.

Aged↗

PubMed2005

One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects.

BACKGROUND: Reconstruction of combined pharyngoesophageal, tracheal, and anterior neck defects is challenging and usually requires two flaps, which is sometimes accompanied by significant morbidity. METHODS: Between March of 2002 and February of 2004, 18 consecutive patients with combined defects of the pharynx and cervical esophagus, trachea, and/or anterior neck skin underwent reconstruction with a single anterolateral thigh flap. The skin paddle was divided into two islands based on separate cutaneous perforators in 10 patients. In the remaining patients with only one cutaneous perforator, a portion of the vastus lateralis muscle was included to support skin grafting for anterior neck resurfacing. The clinical, functional, and aesthetic outcomes of these patients were reviewed. RESULTS: All of the patients experienced complete healing of reconstruction of their anterior neck and tracheal defects with good aesthetic results and only minor complications. The average hospital stay was 7 days. Four patients had a small fistula, which healed spontaneously in three patients but did not heal because of a local recurrence in the fourth. Two patients had a stricture requiring endoscopic dilatation. All but one patient without recurrence tolerated an oral diet. CONCLUSION: Complex neck reconstruction can be accomplished with a single anterolateral thigh flap with good clinical and functional results, minimal morbidity, and quick recovery.

Adult↗

PubMed2005

The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients.

BACKGROUND: A major challenge in head and neck reconstruction in patients with a "frozen neck" is the limited availability of recipient vessels including the carotid artery system. The aim of the present study was to investigate the suitability of the transverse cervical vessels as recipient vessels for free flap reconstruction in head and neck cancer patients. METHODS: Thirty-three sides of necks in 26 patients requiring free flap reconstruction were explored. The presence, location, and size of the transverse cervical vessels were documented. RESULTS: Two arteries (6 percent) and four veins (12 percent) were unavailable. Eight arteries (24 percent) and two veins (6 percent) had a diameter of less than 2 mm, 23 arteries (70 percent) and 18 veins (55 percent) had a diameter of 2 to 3 mm, and nine veins (27 percent) were larger than 3 mm. The contralateral neck was explored because of the lack of suitable ipsilateral vessels in six patients (23 percent). The transverse cervical vessels were unsuitable on both sides in two patients (8 percent). All the available transverse cervical vessels were found to be free of disease. Moderate scarring in the supraclavicular region was present in two cases. All flaps survived without vascular events. CONCLUSIONS: The transverse cervical vessels were thus suitable as recipient vessels in 92 percent of patients and should be the first choice in difficult head and neck reconstructions.

Adult↗

PubMed2005

Reconstruction for total and near-total glossectomy defects.

Reconstruction of total or near-total glossectomy defects has been challenging and the functional outcomes are often disappointing. In this article, the 10-year experience of total or near-total tongue reconstruction at the University of Texas M.D. Anderson Cancer Center is reviewed. The trends of surgical and functional outcomes, length of hospital stay, and choices of flaps and recipient vessels are identified. In addition, the investigators' experience, as well as a literature review, of sensory and motor reinnervation for tongue reconstruction is presented.

Adult↗

PubMed2005

Functional outcomes after circumferential pharyngoesophageal reconstruction.

OBJECTIVE: To determine functional speech and swallowing outcomes, morbidity, and complication rates after reconstruction of circumferential pharyngoesophageal defects using a jejunal versus an anterolateral thigh (ALT) flap. STUDY DESIGN: Retrospective analysis. METHODS: We reviewed the medical records of 58 patients with circumferential pharyngoesophageal defects, 27 with ALT flap reconstruction, and 31 with jejunal interposition. We compared complication rates, intensive care unit (ICU) and hospital stays, nutritional intake, number of tracheoesophageal punctures (TEPs) performed, TE speech fluency, and functional use. Modified barium swallow studies assessed swallowing physiology. RESULTS: Patient characteristics were similar. Total flap loss occurred in one (3.7%) patient with an ALT flap and two (6.5%) patients with jejunal interposition (P = 1.000), fistula in two (7.4%) ALT patients and one (3.2%) jejunal patient (P = .5931), and anastomotic stricture in four (15%) ALT patients and six (19.4%) jejunal patients (P = .7371). ICU and hospital stays were greater for jejunal patients (P = .001, <.001, respectively). TEPs were performed in eight jejunal patients and nine ALT patients. Eighty-nine percent of ALT patients and 63% of jejunal patients were fluent, whereas 78% of ALT patients and 25% of jejunal patients used TE speech to communicate. Ninety-one percent of ALT patients and 73% of jejunal patients resumed oral intake (P = .151). The most common causes of dysphagia were impaired tongue base retraction (62% jejunum) and disordered motility (62% jejunum, 67% ALT). CONCLUSIONS: For circumferential pharyngoesophageal reconstruction, the ALT flap results in similar complication rates, but shorter ICU and hospital stays, and better speech and swallowing compared with jejunal reconstruction.

Adult↗

PubMed2005

Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study.

BACKGROUND: Functional outcomes and morbidities of pharyngoesophageal reconstruction have not been satisfactory. The purpose of the present study was to evaluate such outcomes following pharyngoesophageal reconstruction with the anterolateral thigh flap. METHODS: Reconstruction of pharyngoesophageal defects was performed in 41 consecutive patients with the anterolateral thigh flap. There were 31 circumferential and 10 near-circumferential defects. In the initial nine patients, a portion of the flap was externalized for monitoring by deepithelializing a strip of skin at the distal anastomosis. This technique resulted in a 33-percent fistula rate and was thus modified for the subsequent 32 patients, in whom a true end-to-end, spatulated anastomosis was performed. RESULTS: Total flap loss occurred in one patient, and one patient had partial flap necrosis due to ischemic bowel and sepsis. The mean hospital stay was 6.7 +/- 1.9 days. With the modified technique, fistulas occurred in two out of 25 patients (8 percent) and two out of seven patients (29 percent) with circumferential and near-circumferential defects, respectively, for an overall fistula rate of 13 percent. Strictures occurred in three out of 25 (12 percent) of patients with circumferential defects only. Fluent speech was achieved in all 13 patients who had successful tracheoesophageal prosthesis placement. Among the 34 patients available for diet assessment, two patients (6 percent) required partial tube feeding owing to extensive tongue resection; all other patients tolerated a regular (88 percent) or pureed (6 percent) diet. CONCLUSION: The anterolateral thigh flap offers comparable complication rates, superior speech and swallowing functions, minimal donor-site morbidity, a quick recovery, and a short hospital stay.

Aged↗

PubMed2004

Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction.

BACKGROUND: Although the anterolateral thigh flap has been extensively used for head and neck reconstruction in Asia, reported variations of vascular anatomy seem confusing and may have contributed to the unpopularity of this flap in the United States. The purposes of this study are to classify the vascular anatomy and to assess the suitability of this flap for head and neck reconstruction in a Western population. METHODS: Seventy-two consecutive anterolateral thigh flaps for head and neck reconstruction was retrospectively reviewed. RESULTS: The number of cutaneous perforators for the anterolateral thigh flap ranged from one to three. On the basis of their location and origin, a simple classification system is introduced to assist flap dissection. Of the 72 thighs explored, 68 flaps (94%) were raised successfully. CONCLUSIONS: The vascular anatomy of the flap follows predictable patterns. The anterolateral thigh flap is well suited for head and neck reconstruction in Westerners.

Adult↗

PubMed2004

Reinnervated anterolateral thigh flap for tongue reconstruction.

BACKGROUND: Total or near-total glossectomy defects are commonly reconstructed with rectus abdominis myocutaneous flaps for coverage. Sensory reinnervation has rarely been performed. METHODS: Thirteen consecutive total or near-total glossectomy reconstructions were performed in a 12-month period with anterolateral thigh flaps with (n = 8) or without (n = 5) sensory reinnervation to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament testing, pain, and temperature testing were performed before and after 12 months of surgery. Speech and swallow functions were assessed with an established grading system. RESULTS: Innervated flaps had superior sensory recovery to noninnervated flaps in all testing modalities. Postoperative radiotherapy may delay sensory recovery. Swallow function was better in the innervated group. Return of sensation also improves overall patient satisfaction. CONCLUSIONS: The reinnervated anterolateral thigh flap is a viable option to reconstruct total or near-total glossectomy defects with good speech and swallow functions.

Aged↗

PubMed2002

Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction.

This study presents the authors' experience using the anterolateral thigh fasciocutaneous flap for complex perineal and scrotal reconstruction. Anterolateral thigh fasciocutaneous island flaps were performed in seven patients between January and June of 2000 (six male, one female; mean age, 52 years; age range, 9 to 72 years). Four of the seven patients had scrotal or perineal defects after multiple debridements for Fournier's gangrene. Two of these four had exposed testicles. Three flaps were used for recurrent ischial ulcers. A true septocutaneous perforator (type 1) running between the rectus femoris and the vastus lateralis muscles was found in only two patients. In four patients, the cutaneous perforators were found to be intramuscular, originating from the descending branch (type 2). In the other patient, the musculocutaneous perforator originated from the lateral circumflex femoris artery independently (type 3). In these cases, intramuscular dissections were performed to follow each perforator to its main trunk. Mean follow-up was 8 months (range, 5 to 10 months), and all flaps survived. Three patients developed minor wound dehiscence in the posterior aspect of the perineal wound because of fecal contamination and skin maceration. Both wounds healed secondarily. Scrotal reconstruction with the anterolateral thigh flap gave an excellent aesthetic result. The authors conclude that the anterolateral thigh flap is a reliable flap for perineoscrotal reconstruction.

Adolescent↗