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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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The U-Turn Tournedos (UTT) Flap: A Technical Surgical Evolution for Deep Complex Calvarial Defects.

Lucie Lessard1, Dino Zammit

  • 1Division of Plastic and Reconstructive Surgery, MUHC, McGill University, Montreal, QC, Canada.

The Journal of Craniofacial Surgery
|June 21, 2022
PubMed
Summary

The U-turn technical addition to the latissimus dorsi free flap improves oncological calvarial defect reconstruction. This technique enhances defect filling and aesthetic outcomes while maintaining safety.

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Area of Science:

  • Plastic Surgery
  • Microsurgery
  • Oncology

Background:

  • Complex oncological calvarial defects pose significant reconstruction challenges.
  • High complication rates (38%) include infection, meningitis, and hardware exposure.

Purpose of the Study:

  • To evaluate the safety and efficacy of the U-turn technical (UTT) addition for complex oncological calvarial defect reconstruction.
  • To assess the UTT addition's impact on defect filling, durability, and aesthetic outcomes.

Main Methods:

  • A case series of microsurgical reconstructions using the UTT addition of a latissimus dorsi myocutaneous flap.
  • Flap harvested, deepithelialized, turned over, and shaped into a U-configuration for defect closure.

Main Results:

  • Seven complex reconstructions utilized the UTT addition with no reported complications (e.g., thrombosis, infection, CSF leak).
  • All reconstructions achieved stable volume and full coverage, with subsequent debulking for optimal aesthetics.
  • The UTT addition provided enhanced volumetric filler, round shape, and improved defect filling.

Conclusions:

  • The UTT addition to the latissimus dorsi free flap offers a superior method for reconstructing large, complex calvarial defects.
  • This technique improves aesthetic results and volumetric filler capacity, even in challenging wound beds.