Letter to the Editor
Comment on: Reconstruction using facial artery system-based flaps. One vascular system for multiple purposes in head and neck reconstructive surgery
Comentario a: Reconstrucción mediante colgajos basados en el sistema de la arteria facial. Un sistema vascular para múltiples usos en cirugía reconstructiva de cabeza y cuello
Olindo Massarelli
, Luigi Angelo Vaira, Giacomo De Riu
Corresponding author
University Hospital of Sassari, Maxillofacial Surgery Unit, Sassari, Italy
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One vascular system for multiple purposes in head and neck reconstructive surgery" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "136" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Olindo Massarelli, Luigi Angelo Vaira, Giacomo De Riu" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Olindo" "apellidos" => "Massarelli" "email" => array:1 [ 0 => "olindo.massarelli@aousassari.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Luigi Angelo" "apellidos" => "Vaira" ] 2 => array:2 [ "nombre" => "Giacomo" "apellidos" => "De Riu" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "University Hospital of Sassari, Maxillofacial Surgery Unit, Sassari, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario a: Reconstrucción mediante colgajos basados en el sistema de la arteria facial. Un sistema vascular para múltiples usos en cirugía reconstructiva de cabeza y cuello" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the article by Gonzalez-Garcia et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> recently published in your journal and in which two works of ours are cited.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Authors reported their experience in 8 consecutive oral cancer reconstructions and in 5 of which the buccinator myomucosal flaps have been utilized. All these flaps were solely pedicled on the facial artery, because the Authors stated that “given the great resistance of the buccal mucosa to venous congestion, it is not necessary to carry the facial vein with this type of flaps, so they will maintain their vitality by remaining pediculated exclusively with the facial artery”.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Their experience consists of two FAMM flaps, one inverted-FAMM flap (that we named NAMMIF<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> because pedicled on nasal angular artery), one FAMMI (or FAMMIF<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>), one t-FAMM (or t-FAMMIF<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a>). The success rate of these flaps was hurt by some complications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Authors describe the FAMMI as a facial artery myomucosal island flap based on the facial artery alone and they report it as the one proposed by Zhao et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> We would like to emphasize that this refinement has not been described by Zhao, rather by Massarelli et al. in a 2012 paper and named “arterialized-FAMMIF (or “a-FAMMIF”).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> This type of flap represents a modified standard FAMM harvesting technique in whom the mucosal pedicle was sectioned, enabling this flap to be rotated only on its artery, to extend flap's applications and avoid the further vestibuloplasty. This flap proved to be useful, but we recommend not to exceed in the flap size because in the absence of facial vein the small microscopic veins surrounding the artery might be insufficient to venous drainage. For larger reconstructions we suggest to harvest a bi-trilobed myomucosal flap shaped on the facial mucosasome encompassing the buccal adjacent one, always providing to raise the facial vein with the flap (FAMMIF).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As bibliographic reference for the t-FAMMIF harvesting, the Authors cited our paper in which the harvesting flap's technique was clarified for the first time.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> This type of flap has been described again in further pubblications.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As clearly stated in papers, the t-FAMMIF is always pedicled both on the facial artery and vein. The flap is then “tunnelized through a short paramandibular tunnel following the course of the vessels to the neck up to the origin of the external carotid artery and the internal jugular vein” and then rerouted by another lingual tunnel through the intraoral soft tissues. By gaining a very long arc of pedicle rotation, this technical refinement allows to virtually reconstruct all areas of the oral cavity or the oropharynx, even those contralaterals.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,5</span></a> In a wide pedicle tunnelling dissection the slender venae comitantes periarterial network could be damaged, increasing flap loss risk. Therefore we strongly advise against raising the flap on the sole artery.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although the Authors cite Massarelli's classification,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> some confusion is still present and our greatest concern is that an erroneous technical information regarding myomucosal island flap harvesting might adverse their acceptance and popularization.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial disclosure</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial disclosure" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstrucción mediante colgajos basados en el sistema de la arteria facial Un sistema vascular para múltiples usos en cirugía reconstructiva de cabeza y cuello" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. 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