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Page 14 of 17 Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08

Aim: Stevens Johnson Syndrome (SJS) is a type IV hypersensitivity reaction commonly triggered by drugs
which results in the uncontrolled destruction of keratinocytes with both cutaneous and mucosal involvement.
A rare and often life threatening disease, SJS has an incidence of approximately 1 to 2 cases per 1 million.
When involvement of the skin surpasses 10% of the body surface area, it is designated as Stevens Johnson/
Toxic Epidermal Necrolysis Syndrome (SJS/TEN). A 19-year-old Hispanic female presented to the pediatric
plastic surgery clinic with severe microstomia caused by bilateral oral commissure fusion post SJS/TEN after
taking sulfamethoxazole/trimethoprim for the treatment of severe chronic acne vulgaris. Here, we report
her successful reconstruction.

Methods: Triangular scar excision and mucosal Y-V advancement commissuroplasty were performed
bilaterally under general anesthesia. The incisions were carefully design to avoid overlapping suture lines
during the healing process.

Results: Our reconstruction commissuroplasty using triangular scar excision and mucosal Y-V advancement
successfully resulted in normalization of the oral opening, and recreation of an esthetically pleasant mouth
contour.

Conclusion: Although non-life threatening, microstomia can limit functionality and cause undue stress to
the patients and their families. Triangular scar excision and mucosal Y-V advancement commissuroplasty
proved to be an effective treatment modality of microstomia secondary to SJS/TEN.

23. Indications and outcomes of single-pedicle versus two-pedicle and multiple
simultaneous thigh free flaps in head and neck reconstruction

Becky B. T. King, Ivan E. Rodriguez, Frederic W.B. Deleyiannis

University of Colorado

Aim: The anterolateral thigh (ALT) free flap is one of the most commonly used flaps for head and neck
reconstruction. Given that perforators of an ALT flap routinely arise sequentially from the descending branch of
the lateral circumflex artery as it descends down the thigh, a long ALT flap can be more reliably harvested than a
wide ALT flap. The purpose of this study is to demonstrate indications and outcomes for single-pedicle ALT free
flaps compared to double-pedicle ALT flaps as well as multiple simultaneous thigh (MST) flaps.

Methods: Our series of 81 consecutive patients undergoing head and neck reconstruction with an ALT flap
was retrospectively reviewed. Receiver operating characteristics curve analysis was performed to determine
our cut-off values for width and length of single-pedicle versus double-pedicle ALT flaps.

Results: Fifty-seven and 18 patients were reconstructed with an ALT flap with one or two pedicles,
respectively. Six patients underwent MST flaps. Defect size (width 12 cm, length 17 cm) for cutaneous defects
(P < 0.05), the presence of divergent mucosal defects, and through-and-through oral cavity or pharyngeal
defects were associated with the use of two pedicles. While operative time was increased for the groups of
double-pedicle ALT flaps and MST flaps, there were no flap complications including partial flap loss, venous
congestion, or wound healing issues from poor flap perfusion.

Conclusion: Harvesting an ALT flap with two pedicles has the potential to reduce flap complications and
should be considered for divergent and extremely wide or long defects.