Functional and aesthetic reconstruction of full-thickness cheek, oral commissure and vermilion

PURPOSE: This paper presents surgical techniques for reconstruction of the cheek, oral commissure and vermillion in the repair of full-thickness cheek defects after resection of buccal-mucosal squamous cell carcinoma. PATIENTS AND METHODS: Four reconstructions in one-stage surgery with either a free radial forearm flap or a rectus abdominis musculocutaneous flap for cheek and oral commissure were carried out. There were combined with a new approach for vermillion advancement flaps. Most challenging was the need not only for morphological reconstruction of the orifice, but also for physiological reestablishment of sphincteric and sensory functions in the vermillion. RESULTS: Morphological and physiological reconstruction of the lip with sphincteric and sensory functions was attained. CONCLUSION: This valuable reconstruction technique was demonstrated in large, full thickness defects involving the cheek, oral commissure and vermilion.     

筋膜悬吊联合前臂皮瓣修复唇或口角缺损10例报道

目的：评价筋膜悬吊联合前臂皮瓣修复唇或口角缺损的形态和功能效果。方法：自2001年以来选择10例唇部和口角缺损病例,按照唇部和口角的缺损范围设计前臂皮瓣,皮瓣与受区行血管吻合,依照缺损长度取大腿阔筋膜或掌长肌腱,在折叠皮瓣内面行筋膜悬吊,将筋膜分别与失去连续性的口轮匝肌和颊肌对位缝合,从而使皮瓣拥有良好的外形,并恢复部分唇部及口角的功能。结果：前臂皮瓣辅助筋膜悬吊后,随访2a以上,皮瓣100％成活,2例患者有轻度的唇部及口角闭合不全,其他患者口角修复外形、发音、咀嚼等基本正常．并可以辅助完成一定的表情功能。结论：采用筋膜悬吊联合前臂皮瓣修复唇或口角缺损,在形态和功能恢复方面有一定优势。     

Primary reconstruction of cheek defect following excision of a large malignant melanoma: Report of a case

A large malignant melanoma of the cheek with metastasis to a submandibular lymph node is described. The tumor was successfully treated by surgical excision and radical neck dissection followed by immunotherapy with intradermal injections of CWS (cell wall skeleton) of noocardia. The cheek and upper lip defects following tumor excision were reconstructed primarily by upward rotation of the cheek and neck skin flap and by lateral advancement of a full-thickness upper lip flap. The oral defect was closed by stretching the distal based mucosal flap from the lower half of the buccal mucosa.     

游离组织辦在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析

目的:探讨不同游离组织瓣在口腔颌面-头颈肿瘤缺损与修复中的应用价值。方法:回顾分析1979年1月～2006年12月间,我院口腔颌面外科所行血管化游离组织瓣移植患者2549例,共制备皮瓣2684块:软组织瓣包括前臂皮瓣、背阔肌皮瓣、胸大肌皮瓣、股前外侧皮瓣、肩胛皮瓣等;骨组织瓣包括腓骨肌皮瓣、髂骨肌皮瓣、肩胛骨肌皮瓣等。分别用于修复舌、腭、颊、口底、颌骨及面颈部大面积复合缺损。统计各年代游离组织瓣移植的成功率,分析失败原因。结果:游离组织瓣移植成功率从80年代初期(92%)至今(98.5%),呈逐年升高趋势,2684块皮瓣总成功率达96.80%。前臂皮瓣是最常用的游离组织瓣(64.12%),胸大肌皮瓣和背阔肌皮瓣在修复大面积复合缺损常被采用,各种骨肌(皮)瓣应用于颌骨缺损修复成为近年的热点。大范围复合组织缺损的救治性手术常需要多个游离组织瓣联合修复重建。结论:血管化游离组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段。前臂皮瓣是修复舌、颊、腭等软组织缺损的首选瓣,胸大肌与背阔肌(皮)瓣适合修复体积较大的缺损,腓骨、髂骨肌瓣是上、下颌骨缺损最常用的修复手段。其他不常用的组织瓣,应根据不同适应证进行选择。采用不同组织瓣修复口腔颌面部缺损,对患者术后外形及功能具有重要意义。     

游离组织瓣修复口腔颌面部缺损183例临床分析

目的:总结游离组织瓣在口腔颌面部软、硬组织缺损修复中的应用及提高其成功率的经验。方法 :2001—2011年(10年)期间,我院行游离组织瓣修复口腔颌面部缺损的病例共计183例,其中前臂皮瓣91例,腓骨复合组织瓣78例,股前外侧皮瓣14例,用于修复舌、颊、腭、口底、上颌骨、下颌骨等部位缺损,回顾性分析其成活率及术后并发症。结果:179块组织瓣成活,总成活率为97.8%,失败率为2.2%。其中前臂皮瓣成活率为96.7%,腓骨复合组织瓣为98.7%,股前外侧皮瓣为100%。结论 :前臂皮瓣是口腔颌面部软组织缺损修复的首选皮瓣,股前外侧皮瓣只有在大范围缺损时使用,对于上、下颌骨缺损均可采用腓骨复合组织瓣修复。术后1周内监测皮瓣,及时发现血管危象并手术探查处理,是保证游离组织瓣成活的关键。     

Closure of radial forearm free flap donor site with local full-thickness skin graft.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.     

Oral commissure reconstruction with split masseter muscle transposition and cheek skin flap

Satisfactory reconstruction of the cheek involving the oral commissure is always challenging. A 64-year-old male patient underwent full-thickness repair of a cheek defect involving the oral commissure following excision of squamous cell carcinoma. Reconstruction was performed with a cheek skin flap combined with split masseter muscle transposition. This method was found to be useful for reconstructing the oral commissure with good functional and aesthetic results.     

对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损

目的: 介绍一种对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损的方法。方法: 对25例口腔鳞癌患者行前臂游离皮瓣修复肿瘤切除术后缺损,在制备前臂游离皮瓣的同时,进行供区对偶三角瓣及邻近小面积全厚皮片的设计和制取,原位修复供区缺损。结果: 25例前臂供区缺损均成功采用供区对偶三角瓣联合原位小面积全厚皮片修复。用于关闭前臂供区缺损的邻近全厚皮片均存活,创口愈合良好,无迟发性创面破裂,未发生供区严重并发症。取瓣侧手臂肘腕关节运动正常,掌部血运正常,前臂皮瓣供区缺损修复区域与周围组织皮肤色泽接近,无凹陷畸形,无挛缩畸形。与腹部取皮组相比,前臂邻近皮片修复组在术后肿胀和腕关节运动没有明显差异的情况下,瘢痕感染几率减少,肌腱外露风险降低,大大提高了前臂术区的美观性。结论: 改良供区对偶三角瓣联合邻近全厚皮片修复技术减少了术中和术后恢复时间,避免第三术区的创伤,值得在临床上应用。     

Bipaddled submental artery flap

Oral cancer is a major public health problem in India. Most patients present with locally advanced disease requiring complex resection and reconstruction strategies. Costs, operating time and availability of expertise are major issues that influence efficient health delivery, especially in developing countries such as India. Technically simple and widely reproducible techniques may be used successfully where applicable, to overcome these issues. The submental artery flap is a well described and acceptable alternative to the radial artery forearm free flap in oral cavity reconstruction. Researchers have demonstrated its technical ease of performance and reproducibility amongst trainees. Here the authors describe the bipaddled submental artery flap, a modification of the standard flap, which can be used to provide lining as well as skin cover for a full thickness cheek defect. Two skin paddles are fashioned taking advantage of the vascular anatomy of the submental vessels.     

肩胛区游离瓣在口腔颌面外科的应用——附21例临床报道

目的详细阐明肩胛区游离瓣的应用解剖、制做技术及临床应用。方法对我科自１９７９年以来，共完成的肩胛区游离瓣移植术２１例，进行了临床分析。结果肩胛区游离瓣以肩胛下血管为蒂，可设计为单纯皮瓣、骨瓣或复合瓣；２１例肩胛区游离瓣移植修复均获成功，主要不足为切取肩胛区游离瓣时，需要更换体位，手术时间相对延长。结论由于前臂桡侧游离皮瓣和腓骨肌皮瓣的广泛应用，肩胛区游离瓣的应用趋向减少。     

Upper-lip reconstruction using a free dorsalis pedis flap incorporating the extensor hallucis and digitorum brevis muscles

The combined dorsalis pedis cutaneous, extensor hallucis and digitorum brevis muscle conjoined free flap is useful for a moderate or subtotal defect of the full-thickness lip when local or regional flaps are not applicable. This method can restore good oral competence, adequate oral aperture allowing dental hygiene, and an ability to purse the lips and create a seal.     

Superficial-layer split-thickness flap for maximal flap release and coronal positioning: a surgical technique

The aim of this report is to describe the superficial-layer split-thickness flap, which provides maximal flap release and mobilization for coronal positioning. The traditional split-thickness flap technique dissects following the contour of the buccal alveolar plate, leaving a periosteal layer on the osseous surface, while the muscular layer remains with the flap. This limits flap mobilization and can lead to flap retraction during healing because of muscle pull from lip and cheek movement. The superficial-layer split-thickness flap technique dissects following the contour of the external surface of the flap, toward the lip or cheek, and separates the epithelium and connective tissue from the underlying muscular and periosteal layers, which remain attached to bone. The advantages of this technique are: (1) the extreme flap release that allows complete, passive flap coverage for virtually all root coverage, ridge preservation, and ridge augmentation procedures; and (2) the absence of muscle pull during healing, which prevents flap retraction and promotes more rapid union of flap margins. Four cases are presented to demonstrate the flap technique and healing advantages.     

Radial flap: a valuable fasciocutaneous flap for intra-oral reconstruction

The radial forearm flap, or the forearm flap, is called "Chinese flap" for its development of the chinese doctors, and is originally designed for the correction to the post-burn contraction of the face and neck. The radial forearm flap is one of the fasciocutaneous flap, supplied by the radial artery, and transferred as a single-stage reconstruction micro-surgically. In oral and maxillofacial region, the deltopectral flap (D-P flap) and the pectralis major myocutaneous flap (P-M-M-C flap) are mainly used for the reconstruction. These flaps, however, are sometimes too bulky and limited to transfer, and more require two-stage operations. On the other hand, as the forearm flap being thin and pliable, some doctors use this flap micro-surgically at single-stage free flap reconstruction. Before two years, we have begun to transfer the radial forearm flap for the intra-oral reconstruction. The operation method is as follows. Design and Elevation of the Radial Forearm Flap 1. Using the ultrasonic doppler flow meter, the radial artery and the subcutaneous forearm veins are marked on the skin. 2. The flap is designed 20% larger according to the pattern to be reconstructed, with the distal section of the radial artery as an axis on the forearm and the median vein of forearm inclusively. 3. Before the operation, Allen test must be performed in order to determine whether the hand will survive without a radial arterial in-put. 4. The operation is performed with a arm tourniquet. The margin of the flap are incised down to the deep fascia, isolating and preserving the proximal subcutaneous veins as required.(ABSTRACT TRUNCATED AT 250 WORDS)     

晚期口腔癌术后颊部大范围洞穿性缺损的修复

目的:评价延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损的可行性。方法:对我院2008年6月—2012年2月施行的17例延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌切除后颊部黏膜和皮肤巨大洞穿性缺损病例进行回顾分析。结果:17例患者均伴晚期口腔癌切除后的颊部软硬组织巨大洞穿性缺损,修复口腔衬里的延长锁骨上岛状筋膜皮瓣大小为10 cm×8 cm～14 cm×10 cm,修复外部缺损的延长垂直下斜方肌岛状肌皮瓣大小为15 cm×8 cm～25 cm×10 cm。所有病例均无严重并发症,随访6～34个月,9例患者无瘤生存,2例带瘤生存,6例死于局部复发及远处转移。结论:应用延长锁骨上岛状筋膜皮瓣复合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损是一种可靠的修复方法,对于再次手术,以及放疗后病例,在一定程度上优于游离皮瓣等其他修复方法。     

前臂桡侧游离皮瓣在口腔颌面外科的应用——附725例临床分析

目的详细阐述前臂桡侧游离皮瓣的应用解剖、制作技术、在口腔颌面外科的应用及新近研究进展。方法对我科自１９７９年以来，７２５例应用前臂桡侧游离皮瓣修复口腔颌面部各类缺损的病例，进行了临床分析。结果前臂桡侧游离皮瓣质地优良、血供可靠已及切取方便，总成功率达９６．６％；主要缺点是牺牲前臂的一条主供血管—桡动脉，供区疤痕明显，影响美观。结论前臂桡侧游离皮瓣是口腔颌面外科应用最多皮瓣，也是修复口腔颌面部软组织缺损的首选皮瓣。     

Microsurgical tissue transfer for rehabilitation of the patient with cleft lip and palate.

OBJECTIVE: Three case reports of microsurgically revascularized tissue transfer for secondary closure of complex oronasal fistulae in cleft lip and palate patients are reported. One scapular and two radial forearm flaps were used in that respect; the scapular flap was transferred without a skin paddle and was left for secondary epithelialization whereas iliac crest bone was transplanted in the two patients with the forearm flaps in a further surgical step. CONCLUSIONS: These microsurgical flaps represent solutions in selected cases of oronasal fistulae in patients with cleft lip and palate with extensive scarring, large defects, or both. Alternative free flaps of the vast spectrum available today, however, also deserve consideration.     

前臂尺侧游离皮瓣在口腔颌面外科的应用——附30例临床报道

目的详细阐明前臂尺侧游离皮瓣的应用解剖、制做技术及在口腔颌面外科的应用。方法对３０例前臂尺侧游离皮瓣修复口腔颌面部缺损的病例，进行了临床回顾性分析。结果前臂尺侧游离皮瓣具有较薄、柔软、弹性好且与面部的色泽相近的优点。它血管蒂长、口径较粗，适合与口腔颌面部的血管吻合。与前臂桡侧游离皮瓣相比，它的供区疤痕相对隐蔽，本组成功率为９０％。主要不足是损失了前臂一条主要供应血管一尺动脉。结论当某种原因，前臂桡侧游离皮瓣不能切取，如桡动脉阻塞，近期曾行桡部静脉穿刺或经该静脉行化疗，这时前臂尺侧游离皮瓣不失为口腔颌面部软组织缺损游离修复的最佳选择。     

100例口腔颌面部游离组织移植的临床分析

目的：对100例口腔颌面部游离组织移植作回顾性分析,方法：分析100例游离组织瓣的类型,受区血管,血管吻合方式和技术,皮瓣成活情况及术后并发症的发生情况,并分析有可能影响皮瓣成活的各种因素。结果：前臂皮瓣,腓骨瓣和腹直肌瓣为最常用的三种游离组织瓣,占全部皮瓣的94％,皮瓣的成功率为97％,皮瓣血栓的发生率为6％,抢救成功率为50％,受区和供区 的并发症发生率为32％,但大多数并发症均不严重,没有造成明显的后果,吸烟,饮酒,放疗和年龄（高龄和儿童）等均非影响游离组织瓣移植成功的重要因素,结论：口腔颌面部游离组织移植安全可靠,其明显优于传统的带蒂组织移植,值得进一步推广和普及。     

上臂外侧皮瓣在口腔癌术后缺损修复中的初步应用

目的 探讨上臂外侧皮瓣（LAFF）在口腔软组织缺损修复重建中的应用价值。方法用上臂外侧皮瓣即刻修复口腔鳞癌根治术后的继发缺损10例。结果 除1例皮瓣坏死外，其余9例组织瓣全部成活，口腔组织形态和功能恢复满意。7例患者供区有麻木感，无其他并发症。结论 与前臂桡侧皮瓣相比，由于LAFF优点诸多，在口腔中小型软组织缺损的修复中，LAFF是一种可选择的优秀皮瓣。     

Reconstruction of full-thickness cheek defect affecting the oral commissure by galeal skin island flap: a case report.

This article describes the use of the galeal skin island flap in the reconstruction of a full-thickness cheek defect affecting the oral commissure, created after radical surgery in a 60-year-old patient suffering from carcinoma of the cheek. Advantages and drawbacks of the described technique are discussed.