Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma

The purpose of this study was to evaluate the outcomes of second salvage surgery with extended vertical lower trapezius island myocutaneous flap (TIMF) reconstruction for patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). The subjects were 23 patients with advanced re-recurrent oral and oropharyngeal SCC undergoing second salvage surgery and reconstruction with a TIMF. A TIMF with a skin paddle measuring 6 cm × 7 cm to 10 cm × 22 cm was used to reconstruct the major defects. Three patients experienced minor complications: minor flap failure (n = 1), wound dehiscence at the donor site (n = 1), and an orocutaneous fistula (n = 1). The patients were followed for 3–72 months. Fifteen patients were alive with no evidence of disease, two were alive with disease, and six died of local recurrence or distant metastases. Second salvage surgery remains an effective treatment modality for select patients with advanced re-recurrent oral and oropharyngeal SCCs, and the extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing the major defect following second salvage surgery.     

Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation

PurposeThe purpose of this study was to consider the indications and evaluate the clinical advantages and disadvantages including, results and complications, of immediate reconstruction using a latissimus dorsi (LD) free flap and reconstruction plate (R-plate) in advanced oro-mandibular tumour resection.Methods and materialsOur cohort included 116 patients who underwent LD free flap and R-plate reconstruction. Flap survival, postoperative function, donor/recipient site complication and aesthetics were evaluated.ResultsOur series demonstrated a 99.1% flap survival rate. One case required a contralateral LD free flap reconstruction after the initial flap failed due to pedicle kinking. Twelve patients needed the plate to be removed and replaced (n = 4, plate fracture; n = 2, plate exposure) or definite reconstruction with free fibular flap and implant installation. Donor site complications included seroma accumulation, scarring, and discomfort of the shoulder girdle. The size of the skin paddle ranged from 6 × 10 cm to 12 × 18 cm (12 were double paddled).The facial contour was acceptable without sagging of the flap. The flap was tolerant to irradiation and was resistant to the exposure of the plate at the symphyseal arch.ConclusionOur series of primary reconstruction with LD free flaps and R-plates showed the retention of mandibular function and the reconstruction of considerably large soft tissue can be achieved successfully. This reconstruction scheme can be indicated for large-volume defects in the oro-mandibular area when the area cannot be covered by a single osteocutaneous free flap, has undergone extensive oncologic resection for advanced or high recurrence rate malignancy and when immediate postoperative chemotherapy and/or irradiation is necessary.     

En bloc resection and reconstruction in patients with advanced recurrent nasopharyngeal carcinoma and radiation-induced sarcoma of the head and neck

The purpose of this study was to assess the outcomes of patients with advanced recurrent nasopharyngeal carcinoma (rNPC) and radiation-induced sarcoma of the head and neck (RISHN) who underwent en bloc resection and reconstruction. Fifty-two patients with advanced rNPC (n = 36) and RISHN (n = 16) underwent en bloc resection and reconstruction with an extended lower vertical trapezius island myocutaneous flap (TIMF). En bloc resection of the tumour (including craniomaxillofacial resections and neck resections) and major defect restoration was successful in all patients. TIMF survival was 92.3%. Postoperative mild hemiplegia occurred in one patient with rNPC. In total, 20 patients (55.5%) in the rNPC group and seven (43.8%) in the RISHN group recovered with no signs of disease at follow-up. No statistically significant difference in recovery status was observed between the rNPC and RISHN groups. En bloc resection of the tumour, including dissection of the carotid artery, ensured microscopic clearance of the disease; this is a viable treatment option for patients with advanced rNPC or RISHN without distant metastasis. The extended vertical lower TIMF is a large, straightforward, and reliable flap for repairing the resultant major defects in the craniomaxillofacial or neck region.     

Donor-site morbidity after fibula free flap transfer: a comparison of subjective evaluation using a visual analogue scale and point evaluation system

The aims of this study were: (1) to compare the visual analogue scale (VAS) with the point evaluation system (PES) in the subjective evaluation of donor-site morbidity after fibula free flap transfer; (2) to compare the functional outcomes of fibula free flap surgery between patients with a normal body mass index (BMI) and patients with a high BMI, and between skin paddle and non-skin paddle harvesting; and (3) to determine the correlation between functional outcomes and related factors. This study included 15 patients who underwent a vascularized fibula free flap transfer for oral and maxillofacial reconstruction. Demographic data, preoperative, intraoperative, and postoperative data were collected. Subjective self-evaluation of functional outcomes was done using a VAS followed by a PES. Comparison of the VAS and PES scores was assessed with Pearson's correlation coefficient. The statistical significance was set at P < 0.05. The VAS score was significantly correlated with the PES score (r = 0.63, P = 0.01). The tourniquet times for the skin paddle group were longer than for the non-skin paddle group (P = 0.02), while the satisfaction score of the non-skin paddle group was higher than that of the skin paddle group (P = 0.03). The VAS is a potential option for the subjective evaluation of donor-site morbidity after fibula free flap transfer.     

Oromandibular reconstruction using microvascularized bone flap: report of 1038 cases from a single institution

This retrospective study was performed to review 1038 patients who underwent mandibular reconstruction with free vascularized bone flaps at a single institution between 2006 and 2017. Of these patients, 827 (79.67%) had fibula flaps, 197 (18.98%) had deep circumflex iliac artery perforator (DCIA) flaps, and 11 (1.06%) had scapula bone flaps. The most common pathological diagnosis was ameloblastoma (n = 366, 35.26%), followed by squamous cell carcinoma (n = 278, 26.78%) and osteoradionecrosis (n = 152, 14.64%). Fifty-seven patients (5.49%) had major complications requiring surgical intervention and one patient died of a pulmonary embolism. Venous crisis was the most frequent major complication (n = 20, 1.93%), followed by haematoma (n = 17, 1.64%) and flap necrosis (n = 14, 1.35%). One-stage mandibular reconstruction was preferred whenever possible, as this generally decreases the financial and hospitalization burden. The four-segment method of jaw reconstruction appeared to achieve good aesthetic appearance results in Asian patients and this was not associated with a higher risk of segment ischemia compared with the three-segment method.     

Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction

The aim of this study was to evaluate the role of computed tomography angiography (CTA) in the diagnosis of vascular stenosis at the vascular pedicle of head and neck microvascular free flaps. A prospective study was done of 65 consecutive patients (49 male, 16 female; mean age 55 years) who had undergone head and neck microvascular free flap reconstruction. All patients underwent 64-slice CTA of the carotid artery. Post-processing with volume rendering reconstruction of CTA images was done. There was excellent inter-observer agreement (weighted kappa = 0.82, 95% confidence interval (CI) 0.74–0.93) in grading of the degree of vascular stenosis. The true sensitivity of CTA for diagnosis of stenosis of the vascular pedicle to the flap was 63% (95% CI 63–100%). Patients with failed flaps showed complete occlusion (n = 2) on CTA and underwent a replacement flap procedure. Patients with failing flaps showed severe stenosis (n = 6) of the vascular pedicle on CTA and underwent revision surgery. There was no change in the degree of stenosis on follow-up CTA for patients with moderate stenosis (n = 9). CTA is a reliable, non-invasive, high-quality imaging tool for the diagnosis and grading of vascular stenosis of the vascular pedicle of head and neck microvascular free flaps.     

Immediate dental implant placement with a horizontal gap more than two millimetres: a randomized clinical trial

The purpose of this study was to evaluate the horizontal dimensional changes in buccal alveolar bone immediately after dental implant placement in the upper premolar area with horizontal gaps >2 mm. A total of 48 patients were enrolled in this randomized clinical trial and were randomly assigned to one of three groups. Group I (flap with graft; n = 16) patients received an immediate implant with bone graft, membrane, and primary flap closure. Group II (flap without graft; n = 16) patients received an immediate implant with primary flap closure only. Group III (flapless without graft; n = 16) patients received an immediate implant without graft, membrane, or primary closure. Cone beam computed tomography (CBCT) scans were obtained preoperatively, immediately after implant placement, and at 6 months postoperative to evaluate horizontal dimensional changes in the buccal alveolar bone. Pain intensity was measured using a numerical rating scale. CBCT examinations revealed that bone had filled the horizontal gap in all three groups. Group II showed the greatest horizontal dimensional changes in the buccal alveolar bone, followed by group I. The least amount of change was recorded for group III. Furthermore, significantly less postoperative pain was recorded in group III when compared to the other groups. Short-term results suggest that the ‘flapless without graft’ technique shows similar results to the ‘flap with graft technique’ for immediate implant placement in the maxillary premolar extraction site with a horizontal gap >2 mm, when the bone plate is intact.     

Head and neck cancer surgery in an elderly patient population: a retrospective review

Should advanced age be a contraindication to the surgical management of head and neck cancer patients? A retrospective chart review was performed of patients aged ≥80 years treated surgically for a head and neck malignancy during the period 1996–2011 in a tertiary care cancer centre. The average follow-up was 32 months. Fifty-three patients were identified (mean age 85 years). Cardiovascular disease was the most prevalent co-morbidity (43%). Forty-five patients (85%) had oral cavity/oropharynx squamous cell carcinoma. Surgeries performed included 40 neck dissections and 12 microvascular free flaps. The average length of hospital stay (LOS) was 6.4 days. An increased LOS was significant in patients requiring free flap reconstruction (P < 0.01). There were no perioperative deaths or free flap failures. The most common postoperative complications were cardiovascular (n = 8), infection (n = 10), and delirium (n = 6). Thirty-four patients were discharged directly home. Free flap reconstruction did not adversely affect discharge disposition (P > 0.05). More than 75% of patients did not report any major limitations to their activities of daily living. Major head and neck surgical procedures can be tolerated by patients of advanced age using careful patient selection. Age alone should not be a primary factor in the management of head and neck cancer patients.     

Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit

There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P = 0.028), diabetes mellitus (P = 0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P = 0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P = 0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005–2012) of the study period (22.2% vs. 79.8%, P = 0.002, and 0% vs. 55.7%, P = 0.064, respectively). There were also declines in recurrent disease (P = 0.008), MRSA (P < 0.001), and duration of admission (P = 0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.     

Resveratrol improves bone repair by modulation of bone morphogenetic proteins and osteopontin gene expression in rats

This study investigated the effect of resveratrol on bone healing and its influence on the gene expression of osteogenic markers. Two calvarial defects were created and one screw-shaped titanium implant was inserted in the tibia of rats that were assigned to daily administration of placebo (control group, n = 15) or 10 mg/kg of resveratrol (RESV group, n = 15) for 30 days. The animals were then sacrificed. One of the calvarial defects was processed for histomorphometric analysis and the tissue relative to the other was collected for mRNA quantification of bone morphogenetic protein (BMP)-2, BMP-7, osteopontin (OPN), bone sialoprotein (BSP), osteoprotegrin (OPG), and receptor activator of NF-κB ligand (RANKL). Implants were removed by applying a counter-torque force. Histomorphometric analysis revealed higher remaining defect in the calvarial defects of the control group than the RESV group (P = 0.026). Resveratrol increased the counter-torque values of implant removal when compared to control therapy (P = 0.031). Gene expression analysis showed a higher expression of BMP-2 (P = 0.011), BMP-7 (P = 0.049), and OPN (P = 0.002) genes in the RESV group than in the control group. In conclusion, resveratrol improved the repair of critical-sized bone defects and the biomechanical retention of implants. Indeed, this natural agent may up-regulate the gene expression of important osteogenic markers.     

Outcomes of younger and older patients with palatal cancer undergoing pedicled facial-submental artery island flap reconstruction

The purpose of this study was to evaluate the outcomes of younger and older patients with palatal cancer undergoing reconstruction using the pedicled facial-submental artery island flap (FSAIF) following cancer ablation. Fifty-eight patients with palatal squamous cell carcinoma (SCC) were divided into two age groups: ≤60 years (n = 31) and >60 years (n = 27). By clinical SCC stage, 6.4%, 83.9%, and 9.7% of the younger group and 3.7%, 85.2%, and 11.1% of the older group were stage I, II, and III, respectively. The incidence of comorbid conditions was 35.5% (11/31) in those ≤60 years and 137.0% (37/27) in those >60 years. Brown class II maxillary defects (four class IIa, 44 class IIb, three class IIc, and seven class IId) were repaired using FSAIFs following cancer ablation. There were two flap failures; thus the success rate was 96.6%. Significant differences in mean age and the incidence of comorbid conditions were evident between the groups. No significant differences in TNM stage, maxillary defect classification, flap size, overall flap survival, rates of local and general complications, or survival status was evident between the groups. The FSAIF is a reliable and safe method for repairing Brown class II maxillary defects following cancer ablation, particularly in older patients.     

Prevention of Frey syndrome with superficial temporal fascia interpositioning: a retrospective study

Frey syndrome (FS) is a commonly documented postoperative complication following parotidectomy. The aim of this study was to clinically evaluate the efficacy of superficial temporal fascia (STF) as interpositioning barrier between the overlying skin flap and the parotid bed for the prevention of FS following superficial parotidectomy. A retrospective study was designed involving a population of patients from a single institution who underwent superficial parotidectomy for parotid tumours and refractory chronic sialadenitis from 2008 to 2011. Forty-eight cases were identified and divided into two groups: group I (n = 25) had undergone STF interpositioning between the skin flap and the parotid bed after extending the modified Blair's incision in the temporal region, and group II (n = 23) had undergone a superficial parotidectomy using the modified Blair's incision without any interpositioning. In group I, one of 25 cases (4%) developed mild FS; in group II, nine of 23 cases (39.1%) developed FS of varying severity. There were no cases of permanent facial palsy in either group. Alopecia along the temporal extension of the incision line was imperceptible in all group I cases. The use of an STF interpositioning barrier between the overlying skin flap and the parotid bed is a safe and effective procedure for the prevention of FS following superficial parotidectomy.     

Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study

Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n = 49), good (25%, n = 23), intermediate (20%, n = 19), or deteriorated (2%, n = 2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P = 0.048). Low age (OR 1.03, P = 0.05) and bilateral joint surgery/operated side (OR 0.24, P = 0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.     

Rationale for a reverse tapered body shift implant for immediate placement

Immediate implant placement holds considerable value, yet primary implant stability is often a critical factor. The aim of this study was to evaluate the stability, volumetric viability, and buccal gap size of reverse tapered body shift (RTBS) implants after immediate placement. Peak insertion torque measurements of two RTBS designs (apical 40% vs. apical 50%), relative to conventionally tapered implants, were assessed in simulated extraction sockets prepared in synthetic bone blocks. Additionally, the proximity of the RTBS implants to neighbouring teeth and anatomical structures, and the buccal gap distance were evaluated in human cadavers. The mean (± standard deviation) insertion torque was 12.00 ± 1.40 N•cm for the conventionally tapered implants (n = 50), 35.36 ± 2.74 N•cm (n = 50) for RTBS-1, and 48.20 ± 2.90 N•cm (n = 50) for RTBS-2; the difference between designs was statistically significant (P < 0.01). In total, 40 RTBS implants (20 per design) were placed in six cadaveric premaxillae. Only one locus was inappropriate for both RTBS implant designs, due to the proximity of neighbouring teeth. The average buccal gap for both implant designs was 2.8 mm (P = 0.104). The improved primary stability and increased buccal gap size with RTBS implants may enhance the feasibility of immediate placement. The study findings should be further validated in clinical trials.     

Healing masseter entheses of mandibular reconstruction with autograft—Raman spectroscopic and histological study

Autogenous bone graft represents the gold standard for mandibular reconstruction. The authors used a beagle mandibular defect model and reconstructed with iliac crest and ulna graft. Healing masseter entheses were harvested 24 weeks after surgery and analyzed by histology and Raman microspectroscopy. The intensity ratio of 960/2940 was to document mineral-to-collagen ratio as degree of mineralization. Pearson correlation was used to evaluate the association between the intensity ratios of 960/2940 and the tendon-to-bone insertion site. In the normal control group (n = 4) and the experimental control group with detached masseter muscle (n = 4), the degree of mineralization at the insertion site increased linearly from tendon to bone. In the iliac graft (n = 4) and ulna graft groups (n = 4), healing entheses were far less mature than controls and a linear trend was not observed. There was no significant correlation between degree of mineralization and insertion site in the ulna group (r_spearman = 0.519, P > 0.001). These results indicate that transplanted bone plays a critical role in healing of entheses and healing enthesis to reconstructed mandible is inferior to normal. Raman spectroscopy provides quantitative information about different healing entheses and gives valuable insight into mechanical properties of entheses in functional mandibular reconstruction.     

Middle mesial canals in mandibular first molars: A micro-CT study in different populations

ObjectiveTo describe the morphological aspects of middle mesial canals (MMC) in mandibular first molars using micro-CT.DesignMandibular first molars collected from the Brazilian (n = 136) and Turkish (n = 122) populations were scanned (voxel size: 9.9 μm) and mesial roots with MMC (n = 48) evaluated regarding several morphological aspects. The incidence of MMC in each population was statistically compared using Chi-square test (α = 0.05).ResultsOverall, the incidence of MMC was 18.6% (48 out of 258 molars) and was significantly higher in the Brazilian (n = 30; 22.1%) than in the Turkish (n = 18; 14.8%) population (p < 0.05). In both populations, confluent configuration of the MMC was the most frequent anatomy. Most of the specimens with MMC had 3 independent orifices (n = 26; 54.2%) and 3 apical foramina (n = 21; 43.8%). The mean minor diameter of the MMC orifice (0.16 mm) was 3 times less than the other orifices (∼0.50 mm). In mesial roots with independent configuration (n = 3; 6.3%), the mean volumes (mm³) of the MMC, mesiobuccal (MBC) and mesiolingual (MLC) canals were 0.20 ± 0.10, 0.75 ± 0.28, and 0.88 ± 0.19, respectively. In the specimens with canal confluence (n = 26; 54.2%), MMC merged to the MBC (n = 8; 16.7%), MLC (n = 4; 8.3%), or to both MBC and MLC (n = 14; 29.2%). Double mesial canal was observed in only 1 specimen. MMC with an independent foramen was observed mostly in Brazilian specimens.ConclusionsIncidence of MMC was higher in the Brazilian molars. Confluent configuration was the most prevalent anatomic variation, while independent and fin configurations, as well as, double MMC, were found only in a few specimens.     

Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series

Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. We have used the medial femoral condyle (MFC) osseocartilaginous flap for repair of TMJ defects. The aim of this paper was to describe our technique and to present the preliminary results. The MFC osseocartilaginous flap was used as a free vascularized graft for TMJ defect in four patients who had undergone resection for benign tumor of the TMJ region (n = 2) or TMJ ankylosis (n = 2). A computer-assisted technique was used in all cases. Symmetry of the mandible was objectively evaluated by postoperative computed tomography. Complications were recorded during follow-up visits. Lower extremity functional status was assessed by the Lower Extremity Functional Scale (LEFC) questionnaire. The MFC osseocartilaginous flap success rate was 100%; bony union was obtained in all four patients, and normal occlusion was achieved within 6–11 months after surgery. No flap-related complications occurred. All patients were satisfied with their postoperative facial symmetry and oral function. The LEFC score ranged from 72 to 80, indicating normal lower extremity function. Vascularized MFC osseocartilaginous flap appears to be a reliable option for reconstruction of large-scale TMJ defects.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

Utility of the lateral arm free flap in oral cavity reconstruction: a single-centre experience with Chinese patients

The lateral arm flap (LAF) may offer an alternative option for oral cavity repair. Twenty-five Chinese patients with oral cavity defects were reconstructed with a LAF. The anatomical characteristics of the flap, the donor site complications, and the functional and aesthetic assessments of recipient site were reviewed. The overall flap survival was 96.0% (24/25patients). The average pedicle length was 7.07 ± 1.09 cm when it was cut off at the insert of the deltoid, with an average arterial diameter of 1.30 ± 0.37 mm and vein diameter of 2.06 ± 0.48 mm. The average flap length was 7.06 ± 1.01 cm, and the average flap breadth was 5.28 ± 0.66 cm, with the average flap size ranging from 18 to 42 cm². One to three reliable perforators supplied the flap, with the proximal, middle, and distal perforators being located at 9.9 ± 1.1 cm, 8.6 ± 1.4 cm, and 5.7 ± 1.2 cm from the lateral epicondyle, respectively. The donor defect was closed primarily and healed uneventfully. A longitudinal scar was the most common morbidity of the donor site. The function and shape of the reconstructed tissues were well restored. The LAF provides a reliable choice for reconstructing medium-sized oral cavity defects, with minimal donor-site morbidity and ideally functional and aesthetic rehabilitation of the recipient site.