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.     

The buccal fat pad flap in oral reconstruction

BACKGROUND: The aim of this study is to describe the surgical technique, indications, advantages, and possible complications of the buccal fat pad flap and to report our clinical experience with this flap for intraoral reconstruction after tumor removal. METHODS: The flap has been used to reconstruct oral defects after tumor resection in 32 patients, who have been retrospectively analyzed. RESULTS: Adequate closure of the defect was achieved during surgery in all cases. In one case, there was partial loss of the flap; this was treated conservatively. In five cases there was some retraction in the reconstructed area. CONCLUSIONS: Buccal fat pad as a flap offers an adequate reconstructive option to be born in mind when reconstructing small to medium defects in the oral cavity. It is a simple and quick surgical technique with a low incidence of complications.     

颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫辦移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面,或充填于腭部的口腔与鼻腔侧组织辦之间,尤其是硬软腭交界处。颊脂垫不需用皮片覆盖,可以自行上皮化。结果共治疗腭裂6例,术后颊脂垫完全成活,无腭瘘形成,无颊间隙感染发生。2周后,颊脂垫自行上皮化。结论颊脂垫血供丰富,易于成活,可为Ⅱ期愈合的创面提供肉芽组织再生床,改善软硬组织血供,以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复。     

颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫瓣移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面，或充填于腭部的口腔与鼻腔侧组织瓣之间，尤其是硬软腭交界处。颊脂垫不需用皮片覆盖，可以自行上皮化。结果共治疗腭裂６例，术后颊脂垫完全成活，无腭瘘形成，无颊间隙感染发生。２周后，颊脂垫自行上皮化。结论颊脂垫血供丰富，易于成活，可为Ⅱ期愈合的创面提供肉芽组织再生床，改善软硬组织血供，以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复     

颊脂垫瓣移转在腭裂修复中的应用

介绍颊脂垫瓣移转的应用原理及用以腭裂修复的实践。方法 将颊脂垫瓣移植于硬腭裂隙的口腔侧创面，或充填于腭部的口腔与鼻腔侧组织瓣之间，尤其是硬软腭交界处。颊脂垫不需用皮片覆盖，可以自行上皮化。结果 共治疗腭裂６例，术后颊脂垫完全成活，无腭瘘形成，无颊间隙感染发生。     

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。     

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。     

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.     

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.     

Total oral reconstruction for cancers associated with advanced oral submucous fibrosis

The progression of submucous fibrosis to oral cancer is well established. This condition in an advanced stage causes progressive trismus. Oral cancers associated with severe submucous fibrosis (interincisor distance [IID] < or = 1.5 cm) require bilateral buccal mucosal reconstruction after tumor excision. After wide excision of the tumor, a regional flap is used to reconstruct the buccal mucosal loss on that side. The opposite buccal mucosa, afflicted by advanced submucous fibrosis, is released at the same time to open the mouth and is resurfaced by an ipsilateral, inferiorly based nasolabial flap. This helps to rehabilitate the oral cavity completely and to prevent the recurrence of trismus. In 18 months, 12 patients underwent total reconstruction of intraoral tumors associated with submucous fibrosis. The average preoperative IID was 0.875 cm. All patients had inferiorly based, two-stage nasolabial flaps for submucous fibrosis reconstruction. The average pain-free postoperative IID was 3.13 cm.     

THE TEMPORALIS MUSCLE FLAP IN INTRAORAL RECONSTRUCTION

Background: Reconstruction following excision of intraoral tumours presents a challenge to the head and neck surgeon. The purpose of the present study was to review the authors' initial experience with the temporalis muscle flap. Methods : A retrospective review of the use of 21 temporalis muscle flaps in intraoral reconstruction at Christchurch Hospital was performed. The muscle was used to reconstruct defects of the oral tongue, tongue base, buccal mucosa, maxilla, soft palate, retromolar trigone and tonsillar region. Epithelial cover was provided by either split-skin grafting or ingrowth from adjacent mucosa. Results: One flap necrosed and one patient developed a wound haematoma requiring drainage. One patient developed a transient frontal weakness. The long-term functional results were excellent, except for one patient with slight tongue tethering. In one patient bilateral flaps were used to reconstruct a bilateral maxillectomy defect. Conclusion : The temporalis muscle flap is a useful option for reconstruction of moderate defects in the posterior oral cavity and oropharynx.     

游离股前外侧皮瓣修复口腔软组织缺损

目的 探讨分析3种游离股前外侧皮瓣在口腔软组织缺损修复中的临床特点与治疗效果。方法 2008年12月至2010年12月收治67例口腔肿瘤患者,切除肿瘤的同时,应用游离股前外侧皮瓣修复缺损处,包括舌、颊、牙龈、口底,通常将皮瓣的旋股外侧动脉降支与受区的颌外动脉或甲状腺上动脉吻合,伴行静脉与受区的面总静脉或颈外静脉吻合。根据游离股前外侧皮瓣的厚度将其分成3种类型：股前外侧肌皮瓣、股前外侧脂肪筋膜皮瓣和薄型股前外侧皮瓣。结果 67例中股前外侧肌皮瓣为35例,股前外侧脂肪筋膜皮瓣17例,薄型股前外侧皮瓣15例。66例皮瓣存活,成功率为98.5％,其中1例糖尿病患者皮瓣发生小部分坏死,经清创换药后痊愈;1例皮瓣完全坏死。67例皮瓣中41例吻合2条静脉,26例吻合1条静脉。8例出现血管危象：6例为静脉血栓（5例抢救成功、1例皮瓣完全坏死）,1例为术区血肿,1例为穿支血管扭转,经过相应处理,血管危象均得到缓解。术后随访2～ 24个月,平均8.7个月,受区组织缺损修复效果满意,供区创面愈合良好。结论 游离股前外侧皮瓣的受区功能良好,供区并发症少,是一种修复口腔软组织缺损的较为理想的方法。     

Dorsalis pedis free flap in oromandibular reconstruction

This paper reports the free dorsalis pedis flap as a fasciocutaneous and osteocutaneous flap in oromandibular reconstruction. The authors present a 7-year series of nine patients with squamous cell carcinoma of oral cavity with extensive soft tissue/soft tissue and bone defect in whom this flap was used for intraoral reconstruction. The free fasciocutaneous flap (two neurosensate) was used in eight patients, and in one patient, a free osteocutaneous flap was required. The follow-up period ranged from 2 and 7 years. No ischemic flap complications occurred and a good anatomical and functional reconstruction was achieved in the majority of patients. There was no significant donor area functional disability. One death occurred in the early post-operative period due to multi-organic failure and four deaths in the follow-up period due to recurrence of the oncological disease. The dorsalis pedis free flap was found to be a good alternative tool for reconstruction of the anterior floor of mouth defects (including marginal mandibular defects). This was also used for anterolateral intraoral soft tissue defects. The donor area morbidity is not problem-free, but with good planning and careful flap dissection, it is possible to minimize the sequelae to a very acceptable level.     

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 combined masseter muscle/intraoral cheek transposition (IOCT) flap for primary reconstruction of the dorsal oral cavity.

A method for primary reconstruction of the dorsal oral cavity after tumor resection of T2 or small T3 tumors is presented. By combination of the masseter muscle flap with a cranial pedicled intraoral cheek transposition (IOCT) flap, a reconstruction of the defects with two layers of tissue is possible. This easy and functional reconstruction method is especially useful for high-risk patients because of the markedly reduced operating time.     

To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects.

The anterolateral thigh (ALT) flap has achieved popularity recently for free-flap reconstruction of intraoral defects following excision of squamous cell carcinoma. We have assessed the feasibility of the ALT flap as a free flap for oral lining and the potential use of the thinned ALT flap in a one-stage reconstruction. We used the ALT flap to reconstruct the oral cavity in 18 consecutive patients between December 2000 and December 2001 following intraoral resection of squamous cell carcinoma. Twelve patients underwent reconstruction using a standard ALT flap, four patients received a thinned ALT flap in a one-stage procedure, one patient received a standard ALT flap in combination with a fibula flap and one patient received a combination of a standard ALT flap and vascularised iliac bone. There were no complications in any of the 14 cases in which a standard ALT flap was used. Two of these flaps were thinned subsequently as secondary procedures. Of the four thinned ALT flaps, one flap failed completely and two flaps experienced partial necrosis. In all but one case the donor site was closed directly with minimal donor-site morbidity. The ALT flap is a versatile flap that can be used in combination with other flaps for more complex defects with minimal donor-site morbidity and is a useful alternative in the armamentarium of the head and neck surgeon. Thinning of the flap is best performed as a secondary procedure, should it be required.     

Immediate full-thickness facial defects reconstruction using the radial forearm free flap

Summary The restoration of composite tissue defects of the oral cavity involving skin and mucosa remains a difficult problem for reconstructive surgeons. A method for immediate one-stage reconstruction of combined intraoral and facial defects with the radial forearm free flap is described. Four patients operated on between July and December of 1991 for advanced squamous cell carcinoma of oral cavity involving oral mucosa, skin and in two cases the mandible were reconstructed with a radial forearm flap to obtain reconstruction of facial and intraoral mucosa. The area of the fold is deepithelialized to be sutured to adjacent tissue.     

Buccal mucosal transposition flap for reconstruction of oropharyngeal-oral cavity defects: an analysis of six cases.

BACKGROUND: Operation on tumors situated in the posterior part of the oral cavity is a challenging aspect of head and neck surgery. Both the approach and the postablative reconstruction of the remaining defect require special procedures. An arsenal of reconstructive methods are available depending on the size and complexity of the defect. The goal should be to employ the simplest surgical reconstructive method, resulting in the best functional result and allowing for later complex oncotherapy. OBJECTIVE: To study the outcomes of patients treated using buccal mucosal transposition flaps for reconstruction of posterior oral cavity and oropharyngeal border defects. STUDY DESIGN: A total of 6 patients with defects of the posterior oral cavity and mesopharynx were treated with buccal mucosal transposition flaps. The patients were followed for up to 24 months. RESULTS: Defects ranging from 12 to 27 cm 2 were reconstructed with the buccal mucosal transposition flap. One patient developed an orocutaneous fistula and 1 had some trismus requiring a Z-plasty scar reorientation. One patient suffered from nasal regurgitation. Five of the 6 patients lived past 24 months, the time of follow-up of this study. CONCLUSIONS: The buccal mucosal transposition flap, with its random pattern of circulation, used alone proved to be a safe method to reconstruct soft tissue defects or line exposed hard tissues located in the posterior oral cavity and oropharynx.     

Reconstruction of the complete loss of upper and lower lips with a chimeric anterolateral thigh flap: a case report

It is difficult to totally reconstruct the lips and achieve good functional and aesthetic results, such as oral sphincter function, sensation, appearance, color, and movement. There have been few reports of reconstructing complete lip defects. We present a case of completely reconstructing the lip defects of a 55-year-old patient who had verrucous carcinoma of the buccal mucosa and lips. Extensive ablation was performed by wide bilateral excision of the buccal mucosa and marginal resection of the anterior mandible and both lips. The tongue, partial tongue base mucosa, and retromolar trigone were preserved. To reconstruct and resurface the intraoral and lip defects nearly totally, we applied a free anterolateral thigh (ALT) flap in chimeric style with two independent sets of perforators and skin islands. To achieve better oral function and cosmetics, revisions of the ALT flap, full-thickness scrotal skin grafting, autologous fat grafting, and skin tattooing were done in stages. Postoperative oral sphincter function was obtained without drooling; the general appearance of the lips was also acceptable.     

The buccal fad pad lined with a metabolic active dermal replacement (Dermagraft) for treatment of defects of the buccal plane.

The buccal fad pad flap (BFPF) is an easy to raise pedicled flap for closure of intraoral defects with barely any donor defect. The major disadvantage of the BFPF is the missing epithelial lining, which can induce fibrous tissue formation with resulting functional impairment. To overcome this problem we lined the BFPF with a dermal replacement (Dermagraft) consisting of living metabolic active fibroblasts. In six patients, defects resulting from tumour removal were reconstructed with a combination of the BFPF and Dermagraft and followed up for at least 2 years. In all patients a defect closure was achieved with no functional impairment. The clinical character which was achieved was more a type of defect regeneration than a flap closure. The availability of bioengineered metabolic active tissue can overcome the major problem of the BFPF as an option for defect closure of the buccal side. Furthermore the regeneration of the defects optimises clinical tumour monitoring.