Distal skin paddle as a monitor for buried anterolateral thigh flap in pharyngoesophageal reconstruction

For buried flaps in the head and neck, direct monitoring of the flap can be extremely difficult. The authors report their experience with 22 patients who underwent pharyngoesophageal reconstruction using an anterolateral thigh (ALT) fasciocutaneous perforator flap with a design that addresses the concerns of buried flap monitoring. This is an observational study of 22 patients, who underwent pharyngoesophageal reconstruction with ALT fasciocutaneous flaps between June 2006 and February 2008. The design of the flap consists of three components: proximal component of flap for pharyngeal reconstruction, mid-component de-epithelized for esophageal-skin flap junction, and distal component either as an external sentinel monitor or for replacing the external neck skin, nourished solely by the suprafascial plexus. The patients' age ranged between 40 and 72 years with a mean age of 55.5 years. The measurements of the skin paddles of the ALT flaps ranged from 10 to 30 cm in length and 6 to 8 cm in width. The flap success rate was 95.5% (21/22). The overall sensitivity and specificity rate of this monitoring method is 100% and 94.7% respectively. There were venous congestions found in four skin paddles. One was demonstrated to be false positive after re-exploration. The other three were true positives and two of these were salvaged successfully. The remaining flap could not be salvaged due to severe deep neck infection. Three patients had a small fistula at the distal end of the esophageal-skin flap junction. All healed spontaneously after conservative treatment. This ALT flap design for pharyngoesophageal defect reconstruction is simple and versatile. The distal skin flap can be utilized as an external sentinel monitor for the buried part of the flap, and for resurfacing of the anterior neck skin if required.     

The Bozola flap in oral cavity reconstruction

The buccinator musculomucosal flaps are actually considered the main reconstructive option for small-moderate defects of the oral mucosa. In this paper we present our experience with the posteriorly based buccinator musculomucosal flap. A retrospective review was performed of all patients who had had a Bozola flap reconstruction at the Operative Unit of Maxillo-Facial Surgery of Parma, Italy, between 2003 and 2010. The Bozola flap was used in 19 patients. In most cases they had defects of the palate (n=12). All flaps were harvested successfully and no major complications occurred. Minor complications were observed in two cases. At the end of the follow up all patients returned to a normal diet without alterations of speech and swallowing. We consider the Bozola flap the first choice for the reconstruction of defects involving the palate, the cheek and the postero-lateral tongue and floor of the mouth.     

应用游离股前外侧皮瓣修复头颈部软组织缺损

背景与目的：股前外侧皮瓣（ALT）对供区创伤小,有独特优点,但目前临床应用还不常见。本文探讨应用ALT皮瓣修复头颈部软组织缺损的临床价值。方法：回顾2004年11月至2008年5月期间于中山大学肿瘤医治中心20例应用ALT皮瓣修复重建头颈部软组织缺损的病例资料。总结皮瓣切取的技术细节。报告术中解剖和成功率。结果：20例游离股前外侧皮瓣修复头颈部软组织缺损均获成功。ALT皮瓣血管蒂长介于5～14cm,平均9．9cm。切取的面积介于（4～9cm）×（6～16cm）。皮肤穿支的解剖类型分为肌间隔穿支4例（占20％）,肌皮穿支16例（占80％）。股前外侧皮瓣用于修复的头颈部缺损包括口腔内黏膜缺损14例（其中修复舌体及口底9例、口颊黏膜3例、硬腭1例、以及磨牙后区黏膜1例）．面部及颈部皮肤缺损6例。皮瓣供区除1例以外均可一期缝合。结论：股前外侧皮瓣是头颈部各种软组织缺损修复重建中一个很有价值和应用潜力的供区,具有成功率高,对供区影响小的特点。     

颈阔肌肌皮瓣修复口腔恶肿瘤术后软组织缺损

目的:探讨颈阔肌肌皮瓣修复口腔恶性肿瘤切除术后组织缺损的方法并评价其修复效果.方法:2003年6月～2005年9月,应用颈阔肌肌皮瓣修复舌、颊、口底、咽侧壁及软腭缺损20例.其中男10例,女10例,年龄40岁～74岁.平均59岁.颊黏膜癌4例,舌癌7例,牙龈癌5例,颊部及咽侧壁及软腭癌2例,下颌骨中心性癌1例,舌下腺癌1例.均行病变扩大切除及颌颈联合根治术,缺损范围4.5 cm×5.5 cm～7.0 cm×6.0 cm,应用颈阔肌皮瓣修复软组织缺损,皮瓣范围9.5 cm×4.5 cm～12.0 cm×6.0 cm.结果:术后20例皮瓣均成活,外形无异常,张口不受限.随访9个月～36个月,无舌运动受限等并发症,肿瘤无复发,患者对术后形态及功能均较满意.结论:颈阔肌肌皮瓣解剖恒定,血运丰富,手术操作简便,成活率高,是修复口腔肿瘤术后组织缺损的理想方法,值得推广应用.     

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction

BackgroundAdvanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation.MethodsCase series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale.ResultsA total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%.ConclusionsThe double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation.Clinical question/ level of evidenceTherapeutic, IV.     

股前外侧皮瓣在外阴肿瘤术后的修复应用

目的：评价股前外侧皮瓣在外阴肿瘤术后缺损修复中的应用价值。方法：应用带旋股外侧动脉降支和股前外侧皮神经为蒂的股前外侧皮瓣一期修复外阴肿瘤术后缺损１０例,皮瓣大小为１０ｃｍ×１４ｃｍ～１４ｃｍ×２０ｃｍ。结果：１０例皮瓣全部成活,随访２～１２个月,外观满意,皮瓣感觉功能存在,局部肿瘤无复发。结论：股前外侧皮瓣血管蒂长,血管口径大,供瓣区隐蔽。带感觉神经的股前外侧皮瓣是一种适合外阴肿瘤术后缺损修复的理想皮瓣。     

颈阔肌肌皮瓣修复口腔恶肿瘤术后软组织缺损

目的探讨颈阔肌肌皮瓣修复口腔恶性肿瘤切除术后组织缺损的方法并评价其修复效果。方法2003年6月~2005年9月,应用颈阔肌肌皮瓣修复舌、颊、口底、咽侧壁及软腭缺损20例。其中男10例,女10例,年龄40岁~74岁。平均59岁。颊黏膜癌4例,舌癌7例,牙龈癌5例,颊部及咽侧壁及软腭癌2例,下颌骨中心性癌1例,舌下腺癌1例。均行病变扩大切除及颌颈联合根治术,缺损范围4.5cm×5.5cm~7.0cm×6.0cm,应用颈阔肌皮瓣修复软组织缺损,皮瓣范围9.5cm×4.5cm~12.0cm×6.0cm。结果术后20例皮瓣均成活,外形无异常,张口不受限。随访9个月~36个月,无舌运动受限等并发症,肿瘤无复发,患者对术后形态及功能均较满意。结论颈阔肌肌皮瓣解剖恒定,血运丰富,手术操作简便,成活率高,是修复口腔肿瘤术后组织缺损的理想方法,值得推广应用。     

股前外侧皮瓣修复口底癌术后缺损

目的:评价股前外侧皮瓣在口底癌术后缺损修复中的应用价值.方法: 2005年3月至2007年6月,应用吻合血管的股前外侧皮瓣一期修复口底癌术后缺损10例.皮瓣大小为12cm×5cm至6cm×4cm.结果:10例皮瓣全部成活,外观满意.口腔功能基本恢复.随访2月到26个月,10例患者均健在.其中1例于术后6个月局部复发,再次行局部扩大切除及股前外侧皮瓣修复.结论: 吻合血管的股前外侧皮瓣血管蒂长,血管口径大,供瓣区隐蔽.是一种适合口底缺损修复的游离皮瓣.     

Single stage Delto-pectoral flap cover for large defects following extensive neck dissection

Bulky neck nodal disease with involvement of the overlying skin develops large post resection defects with skin loss following extensive neck dissection, that may not be suitable for primary closure. We describe a simple and easy to do procedure for cover of such large post surgical resection neck defects by using the Delto-pectoral flap as a single staged procedure.     

修复口腔癌术后缺损的股前外侧皮瓣供区积液的临床分析

背景与目的：股前外侧皮瓣（anterolateral thigh flap，ALTF）是口腔癌术后修复最常用的皮瓣。通过回顾分析口腔癌手术病例，探讨如何最大限度地降低ALTF制备术后供区积液的发生率。方法：选择2018年4月—2018年12月于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科住院的病例，共149例，根据ALTF制备及供区处理方式的不同，分为3组：第1组，大腿阔筋膜上制备ALTF（阔筋膜上ALTF）37例，关创时将阔筋膜对位缝合，术后大腿供区未行加压包扎；第2组，大腿阔筋膜下制备ALTF（阔筋膜下ALTF）66例，术后因阔筋膜缺损多、张力过大，不能拉拢缝合，术后大腿供区配合绷带加压包扎；第3组，大腿阔筋膜下制备ALTF 46例，术后阔筋膜缺损多、张力过大，不能拉拢缝合，术后大腿供区未行绷带加压包扎。术后随访1个月，观察大腿供区积液发生情况。结果：大腿供区术后积液总的发生率为10.07%，其中第1组积液发生率为0.00%，第2组积液发生率为10.61%，第3组积液发生率为17.39%，各组间比较差异有统计学意义（P<0.05）。结论：大腿阔筋膜上制备ALTF较阔筋膜下制备ALTF的供区处理方式能够有效降低供区术后积液的发生率。对已制备阔筋膜下ALTF的病例，对大腿供区进行加压包扎，可起到降低供区积液发生率的作用。     

The submental island flap for reconstruction of intraoral defects in oral cancer patients

The submental artery island flap (SIF) is gaining acceptance as a simple and reliable option in selected oral oncologic reconstructions. The present study aims to assess the usefulness of submental artery flap in oral reconstruction with respect to flap reliability, cosmesis, function, donor site morbidity and oncological safety. Thirty (30) patients who underwent ablative surgery and reconstruction using the submental artery island flap for oral cancer at Regional Cancer Centre, Trivandrum, India, between October 2004 and December 2006 were prospectively studied for the flap viability, cosmesis, function (speech and swallowing) and locoregional recurrence. The site and stage of the tumour, type of resection, management of the neck and the technique of flap transfer were recorded and the patients were followed up to assess the status of the flap and its donor site and the oncologic outcomes. There were 19 men and 11 women, ages of whom ranged from 30 years to 78 years with a mean+/-SD of 53+/-11 years. With the exception of one patient who had undergone neck dissection as part of a previous surgery, all patients underwent neck dissection or at least a level I clearance along with the wide excision of the primary lesion. The follow up period ranged from 4 to 25 months with a median of 13.5 months. Six patients either recurred locoregionally or had metachronous second primary constituting an over all recurrence rate of 20%. The size of the skin paddle ranged from 3 x 3 cm to 7 x 6 cm, with a mean size of 4.9 x 4 cm. One total and one partial flap loss were observed. One patient had intractable hair growth on the flap even 3 months after surgery. Donor site healing was excellent in all cases and the donor site scar was well hidden. The long term cosmesis and functions were good in all the patients. The submental artery island flap is a simple and reliable option for oral cancer reconstruction in carefully selected cases, with acceptable cosmetic and functional results and reasonable oncological safety.     

股前外侧皮瓣在外阴肿瘤术后的修复应用

Objective  

The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor.     

Osteomyocutaneous flap reconstruction for major mandibular defects

Mandibular defects after composite resections for carcinoma of the buccal mucosa require immediate restitution of both form and function with an acceptable cosmetic result. The pectoralis major osteomyocutaneous flap (PM-OMC) provides restoration of bone, soft tissue and skin with minimum morbidity. The procedure is technically simple, and in our series reconstruction using this flap has been performed by consultants, fellows and residents in training. We present a series of 116 PM-OMC flaps with good postoperative mastication in more than 70% of cases, and satisfactory swallowing and intelligible speech in 85% patients. © Wiley-Liss, Inc.     

股前外侧肌皮瓣在舌根缺损修复中的应用

目的 探讨股前外侧肌皮瓣修复舌根缺损的效果。方法 应用股前外侧肌皮瓣修复舌根鳞癌术后缺损一例，术后随访。结果 术后创口一期愈合，一年后随访舌体外形良好，吞咽及语言功能满意。结论 该肌皮瓣动脉血管蒂恒定、皮下脂肪较厚，适于修复舌根软组织缺损；皮瓣血管口径较大．易于吻合；供区隐蔽，取瓣方便。     

Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients--a quality of life analysis

We aimed to compare the differences between free flap and pectoralis major myocutaneous flap (PMMF) for reconstruction in oral cavity cancer patients. Patients who received free flap or PMMF reconstruction after ablation surgeries were eligible for the current study. The patients' demographic data, medical history, and quality of life scores were collected and analyzed. A total of 491 patients' records were obtained. Among them, 100 patients completed a quality of life questionnaire. No significant differences could be found in age, morbidity, stage, and hospitalization between the free flap and PMMF groups. However, there were significant differences between both groups in gender, primary site, peri-operative blood loss, and operation duration. Patients reconstructed with free flap had better speech and shoulder functions as well as better mood status. Data from this study provide useful information for physicians and patients during their discussion of treatment modalities for oral cancers.     

应用折叠型游离股前外侧皮瓣修复面颊贯通性缺损12例

目的：探讨折叠型游离股前外侧皮瓣在修复面颊贯通性缺损中的临床应用效果。方法：2010年1月至2014年10月,在中山大学附属肿瘤防治中心应用折叠型游离股前外侧皮瓣修复12例面颊贯通性缺损的患者。分析获取游离股前外侧皮瓣的手术过程、血管吻合技巧以及皮瓣存活率。结果：11例皮瓣存活,1例因术后静脉血栓形成而坏死。在12例患者中,游离股前外侧皮瓣的供区均一期缝合,供区的线性瘢痕隐蔽性好,且供区大腿的功能不受影响。结论：游离股前外侧皮瓣具有良好的可塑性,折叠后可同时修复面颊贯通性缺损的内侧及外侧,具有供区并发症少、外观易接受及患者满意率高的优点。