颊脂肪垫瓣在修复口腔颌面部缺损中的应用

目的探讨颊脂肪垫瓣在修复口腔颌面部缺损的应用和效果.方法将颊脂肪垫形成一蒂在后方的颊脂肪垫组织瓣转移至缺损区,在无张力下与创缘缝合,表面轻轻用碘仿纱布缝线包压法固定.用以修复口腔颌面部的良恶性肿瘤手术或损伤留下的缺损以及口腔上颌窦瘘共18例.其中修复腭部缺损2例,上颌骨切除后缺损7例,颊黏膜癌切除后缺损3例,颊部良性肿瘤切除后缺损4例,磨牙后区黏表癌切除后缺损1例,封闭拔牙后口腔上颌窦瘘1例.结果术后10 d去除碘仿纱布,见颊脂肪垫轻度水肿,2～4周后水肿明显消退,颊脂肪垫表面逐渐上皮化,6～8周内表面完全上皮化,3个月后再生黏膜与正常口腔黏膜相似.全部病例效果满意,无感染、坏死等并发症发生.结论带蒂颊脂肪垫瓣修复口腔颌面部缺损,方法简单、易行,效果满意,值得推广.     

Pedicled buccal fat pad flap for intraoral malignant defects: A series of 29 cases

A buccal fat pad (BFP) as a flap for reconstruction of defects in the oral cavity has been described for a variety of benign conditions. We describe the indications, advantages, and complications of the BFP flap and report our clinical experience with the flap for intraoral reconstruction after tumor removal. From 2005 to 2008, we analyzed 29 patients in the age range of 32 to 82 years old who underwent a pedicled BFP flap reconstruction for oral defects after intraoral tumor removal. Postoperative wound healing and complications including any recurrence was followed-up prospectively. Most of the patients had an uneventful immediate postoperative period with signs of buccal fat pad epithelialization by the end of the first week and complete epithelialization at the end of the first month. On continued follow-up, a linear band of fibrous tissue under the epithelialized mucosa replaced the once reconstructed buccal fat pad. Three patients had varying degrees of hemorrhage: one of them had hematoma that healed with severe fibrosis and of the remaining two, one had a partial flap loss and one had a complete flap loss. Judicious use of buccal fat pad reconstruction offers a simple, convenient, and reliable way to reconstruct small to medium defects of the oral cavity with low morbidity, even in older patients who would not be able to tolerate time-consuming flap reconstruction procedures.     

The buccal fat pad in oral reconstruction.

We describe the indications, advantages, and complications of the buccal fat pad (BFP) flap and report our clinical experience with the flap for intraoral reconstruction after tumour removal. METHODS: From 1993 to 2002, a pedicled BFP flap was used to reconstruct oral defects after tumour removal in 15 patients, prospectively analysed. RESULTS: Adequate closure of the defect was achieved. In seven cases there was some retraction of the BFP. CONCLUSIONS: The BFP, as a flap, offers a good and simple option in the reconstruction of small to medium defects in the oral cavity, above all in older patients. The greatest disadvantage is that reduction in oral opening could occur, to an unpredictable degree.     

无覆盖带蒂颊脂垫瓣在修复口腔缺损中的应用

目的：介绍无覆盖带蒂颊脂垫瓣用于口腔缺损修复的实践。方法：将颊脂垫瓣转移到相应的口腔缺损区,暴露的颊脂垫瓣表面无需植皮,可以自行上皮化。结果：共治疗口腔缺损病例13例,均获成功,颊脂垫瓣封闭效果好。结论：无覆盖带蒂颊脂垫瓣作为局部区域性组织转移瓣,对口腔内颊部、软腭和牙槽等部位软组织缺损的修复尤为适宜,是一种口腔内软组织缺损理想的充填材料。     

Reconstruction of oral defects with the pedicled buccal fat pad flap

Pedicled buccal fat pad flaps were used to reconstruct defects produced by resection of tumors of the oral cavity in 21 patients. The indications included defects of the oral mucosa and defects after excision of a benign or malignant tumor, preferably smaller than 5 cm in diameter. The results were excellent, and there was no added morbidity. Only 1 delay failure and 1 complication were observed. The anatomy and surgical technique are described. The results suggest that these flaps are a direct, convenient, and reliable option for the reconstruction of small defects of the oral mucosa.     

颊脂垫瓣在口腔缺损修复中的应用

目的评价颊脂垫瓣在修复口腔黏膜缺损中的应用。方法1998年5月~2004年7月,收治42例各种原因致口腔缺损患者,其中男26例,女16例,年龄25~76岁。颊部鳞癌7例,颊部白斑5例,软腭部鳞癌7例,腭部腺样囊性癌8例,上颌窦癌6例,上颌齿槽突血管瘤5例,上颌骨角化囊肿4例。病程2个月~10年。缺损部位颊部12例,上颌骨切除导致颊部上分缺损6例,口腔上颌窦瘘17例,软腭部缺损7例。缺损范围3.0cm×3.0cm~6.5cm×4.0cm。均采用颊脂垫瓣修复缺损部位,切取的颊脂垫瓣为颊脂垫的颊突及部分体部。结果术后41例颊脂垫瓣与创面期愈合;1例因缺损大,瓣成形后较薄而期愈合。术后4周水肿消退逐渐上皮化,6周完全上皮化,颊部外观无明显影响。35例获随访3个月~5年,颊脂垫瓣修复区与附近正常黏膜的层次和颜色、弹性、光滑度、质地无明显差异,咀嚼摩擦和食物刺激无明显影响。2例磨牙后区缺损者有轻度张口受限,经过开口训练恢复张口度。结论颊脂垫瓣能较快而有效地修复直径6.5cm以下的黏膜缺损,取材方便,术后无明显的供区并发症,是修复颊部、软腭和牙槽等部位黏膜缺损的理想组织。其缺点为修复范围较局限。     

The microvascular osteocutaneous femur transplant for covering combined alveolar ridge and floor of the mouth defects: preliminary report

In this preliminary report, the surgical technique of an oral defect coverage using the microvascular osteocutaneous flap from the distal medial femur is described and three clinical cases are reported. The new flap was used for covering combined defects of the alveolar ridge and the neighboring floor of the mouth after tumor surgery and irradiation. The bone part of the flap was supplied by the descending genicular artery and the soft tissue part by their first emission-the saphenous artery. Anastomoses were performed between the common part of the flap pedicle and cervical arteries or veins. There were no severe complications or transplant loss. All patients were successfully treated with dental implants (n = 12) 4 to 6 months after ridge reconstruction. The microvascular osteocutaneous femur transplant can be used successfully in individual reconstruction of the alveolar ridge and the neighboring floor of the mouth after tumor resection.     

颊脂垫部分摘除术的临床体会

目的：探索一种简单安全有效的颊脂垫摘除术。方法：对30例颊脂垫肥大患者行颊脂垫摘除术,其中28例采用口内小切口径路行颊脂垫摘除术,2例在行面部除皱术的同时行颊脂垫摘除术。结果：对30例患者术后随访1年,其中29例对面型改善效果满意,1例经再行下颌角肥大截除术后亦获满意疗效。结论：口内小切口径路行颊脂垫摘除术是一种理想的颊脂垫摘除手术方法,具有简便性、安全性、微创性、显效性,且并发症少,恢复快,符合美容手术原则。     

Karapandzic flap for reconstruction of lip defects.

PURPOSE: Systematic evaluation of the Karapandzic flap in the reconstruction of lip defects after ablative surgery. PATIENTS AND METHODS: Patients who had a Karapandzic flap to reconstruct lip defects were analyzed with reference to demographic details, histology and location of the tumor, and dimensions of resection. The functional aspects of the reconstruction were assessed in terms of the size of the oral stoma, preservation of oral competence, and facial expression, in addition to speech, diet and ease of cutlery, and denture usage. The esthetic outcome was assessed with a 4-point scale and in addition the symmetry of the commissure at rest and function, preservation of the philtrum, and lip projection also were assessed. The complications were noted. RESULTS: Seven patients underwent Karapandzic flap reconstruction (4 males, 3 females) with an age range of 43 to 98 years. Three tumors were located in the upper lip, 4 in the lower lip, and there were 5 squamous and 2 basal cell carcinomas. The lip defects ranged from 40% to 75% of the lip circumference. The oral stoma was of a reduced circumference in all cases but did not lead to any functional compromise in terms of oral competence, facial expression, speech, diet, denture and cutlery usage, and sensation. There were no wound complications in our series. The esthetic outcome was considered excellent/good in 85% of cases. The commissure was symmetrical in all except 1 patient, the philtrum was preserved in all cases of lower lip reconstruction, and the projection of the lip was reduced in edentulous patients. CONCLUSIONS: The Karapandzic flap is a reliable technique that offers consistently good functional and esthetic outcomes after reconstruction of lip defects.     

Buccal fat pad - a simple, underutilised flap

The pedicled buccal fat pad is a reliable flap for the repair of small oral defects. It is durable, easy to harvest and should be considered in settings where access to free flaps is limited and in cases where previous flaps have failed. We discuss a case where this flap was used successfully for closure of an oro-antral fistula. The indications, anatomy and techniques of successful harvest are discussed.     

Estlander瓣修复下唇癌切除后口角区大部分缺损的临床观察

目的：回顾分析采用Estlander瓣法修复下唇口角区大范围缺损的病例,并进行总结。方法：我院颌面外科2006～2009年5例（男4例,女1例）下唇鳞状细胞癌位于口角区患者,年龄50～63岁。采用Estlander瓣法进行修复,术后观察其形态和功能恢复状况。结果：5例患者皮瓣全部成活且预后良好,术后均未出现静脉回流受阻、流涎等并发症。唇部在3个月后恢复感觉,6个月内恢复收缩功能。口角区的对称性在行二期口角开大术后能够维持美观满意度的标准。结论：Estlander瓣用于修复下唇口角1/3～1/2缺损能够达到满意的临床修复效果。     

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

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.     

Reverse-flow submental artery flap for periorbital soft tissue and socket reconstruction

BACKGROUND: The submental artery island flap is a recently described local flap that may be used for reconstruction of the lower and middle thirds of the face and oral cavity. The reverse-flow manner of the flap has been used in limited cases because of possible drawbacks such as venous congestion. We present our experience with the use of reverse-flow submental artery flap and describe the surgical technique. METHODS: This versatile flap was successfully used for large periorbital soft-tissue defects and socket reconstruction in six patients in the past 2 years. The diagnosis of three patients was basal cell carcinoma of the eyelids, which required orbital exenteration, and the other patient had traumatic periorbital defects. The flap size varied from a minimum of 4 x 6 cm to a maximum of 6 x 8 cm. RESULTS: No major complications were noted other than one case of temporary palsy of the marginal mandibular branch of the facial nerve and one other of venous congestion, which subsided spontaneously. In all patients, the results were satisfactory, with acceptable cosmesis. CONCLUSIONS: The reverse-flow submental artery island flap is safe, rapid, and simple to raise and leaves a well-hidden scar. We believe that this flap surpasses the other flaps in reconstruction of large periorbital soft-tissue defects and socket.     

Free tissue transfer and local flap complications in anterior and anterolateral skull base surgery

BACKGROUND: Advances in reconstructive techniques over the past two decades have allowed the resection of more extensive skull base tumors than had previously been possible. Despite this progress, complications related to these cases remain a concern. METHODS: Univariate and multivariate analyses were used to determine the relationship of host, tumor, defect, treatment, and reconstructive variables to wound and systemic complications after anterior and anterolateral skull base resections. The study included 67 patients receiving local flap (LF) or free tissue transfer (FTT) reconstructions during an 8-year period. RESULTS: Overall, 28% of patients had a major wound complication, and 19% had a major systemic complication. LF and FTT flaps had similar rates of wound complications. LF reconstructions were associated with late wound breakdown problems, and FTT flap complications were primarily acute surgery-related problems. CONCLUSIONS: The surgical reconstruction of skull base defects should be planned on the basis of the ability of the technique to attain safe closure and maintain integrity after radiation therapy.     

The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study

We present an anatomical study on the vascular supply to the patellar fat pad. Forty knees from fresh cadavers were dissected after injecting the femoral artery with colored latex. In all cases, the vascular supply to the fat pad depended essentially on the lateral inferior genicular artery, which enters this structure at its posterolateral extent. In the cases in which the fat pad flap was raised before the injection of latex, we observed good vascularization of the flap by the lateral genicular artery. This is a safe vascularized flap that offers an optimal covering of knee prostheses in fixed valgus knee deformities. An optimal procedure for raising the flap is proposed.     

Le Fort I osteotomy and the use of bilateral bichat bulla adipose flap: an effective new technique for reconstructing oronasal communications due to cocaine abuse

The aim of the study was to describe a new and effective method for reconstructing small- and medium-sized oronasal communications in cases of deficient blood supply of oronasal mucosa.A male patient, aged 45, was presented with a hard palate defect due to chronic cocaine inhalation. The defect was corrected using bilateral Bichat bulla adipose flap and a Le Fort I osteotomy. The surgical technique was described, together with its advantages.Surgery lasted 2 hours. The reconstructive technique had been easy to execute. Six months after the surgery, the defect has been corrected without complications.Le Fort I osteotomy and the use of a bilateral Bichat bulla adipose flap is an effective technique to correct small- and medium-sized palatal defects not solvable with simple oral mucosa flaps. The technique is easy to execute and it showed a high efficacy with minimal impact on the patient's esthetic appearance.     

Vesicovaginal fistula repair with genito-gluteal fold fat pad flap.

We report our experience of supratrigonal vesicovaginal fistula (VVF) repair cases developed after gynaecologic surgery. Two patients presented with urinary incontinence after hysterectomy and adjuvant radiation therapy for cervical carcinoma. Cystoscopy findings showed vesicovaginal fistula near the bladder neck area. In a transvaginal approach, we excised the fistulous tract and transferred the genito-gluteal fold fat pad flap for interpositioning. Postoperative cystography showed no evidence of leakage and no recurrence was found after a 1 year follow-up period. This flap technique is particularly useful for a vaginal cuff area fistula in terms of ease of dissection, lower donor site morbidity and large flap dimension. Also the fat pad provides neovascularity and lymphatic drainage, fills dead space, and enhances granulation tissue formation.     

Malar Fat Pad Elevation: An Aid to Closure

BACKGROUND: In closure of defects inferior to the eye, it is important to avoid inducing lower lid ectropion. OBJECTIVE: To describe a new technique for closure of defects inferior and lateral to the eye. METHODS: A case of malar fat pad elevation to close a post-Mohs surgical defect is described and the procedure is detailed. RESULTS: This technique enabled good wound closure with minimal tension and avoided the complication of ectropion. A transient asymmetry was manifest postoperatively. CONCLUSION: Malar fat pad elevation is an effective and elegant means of closing defects inferior and lateral to the eye. This technique minimizes extensive tissue undermining and movement with its consequences of postoperative tissue swelling, bruising, and hematoma formation. The side effect of ectropion is prevented.     

Use of nasolabial flap for mouth floor reconstruction

SUBJECT: Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. PURPOSE: The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. MATERIAL AND METHOD: We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. RESULTS: Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. CONCLUSION: The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.     

Efficacy of lipomodelling for the management of sequelae of breast cancer conservative treatment

We report a study of 42 breast cancer patients undergoing lipomodelling, or fat transfer, for sequelae of conservative treatment. Detailed clinical and radiological data of the patients have been collected. These data demonstrate the feasibility of lipomodelling: the technique is simple but requires a learning curve to avoid cytosteatonecrotic lesions; the excellent results obtained in terms of shape and softness of the breast; no surgical implant or flap reconstruction is necessary; the reliability of the procedure: there is normal fat wasting within the first months after treatment, then results stabilize as the patient maintains a healthy weight; the small number of side-effects: only rare, predominantly infectious, rapidly resolving complications are induced. In conclusion, the fat transfer approach presented here represents a considerable advance for the management of moderate sequelae of conservative breast treatment. Using this technique makes it possible to restore the shape and softness of the breast better than any other surgical procedure before, particularly for patients with mild breast deformity.