Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects |
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| Institution: | 1. Department of Plastic Reconstructive and Aesthetic Surgery (Head: Prof. N. Kostakoglu, MD), Gaziosmanpasa University, Faculty of Medicine, 60100 Tokat, Turkey;2. Department of Patology, Gaziosmanpasa University, Faculty of Medicine, 60100 Tokat, Turkey;3. Department of Radiology, Gaziosmanpasa University, Faculty of Medicine, 60100 Tokat, Turkey;4. Department of Biostatistics, Sakarya University, Faculty of Medicine, 60100 Sakarya, Turkey;1. APHP (Head: Prof. Vazquez), Hôpital Necker Enfants Malades, Service de chirurgie Maxillofaciale, Paris 75015, France;2. Université Paris V, UFR de Médecine Paris Descartes, Paris 75006, France;3. Centre de références des malformations de la face et de la cavité buccale (Head: Prof. Vazquez), Paris 75015, France;4. Laboratoire de Physiopathologie orale et Moléculaire (Head: Prof. Berdal), INSERM, UMRS 872, Equipe 5, Centre de recherche des Cordeliers, Paris 75006, France;5. APHP (Head: Prof. Garabedian), Hôpital Necker Enfants Malades, Service d''Oto-Rhino-Laryngologie, Paris 75012, France;6. APHP (Head: Prof. Ducou Lepointe), Hôpital Armand Trousseau, Service d''Imagerie Médicale, Paris 75012, France;7. APHP (Head: Prof. Coulomb L''Herminé), Hôpital Armand Trousseau, Service de cytologie et anatomopathologie, Paris 75012, France;8. Université Paris VI, UFR médecine Pierre et Marie Curie, Paris 75005, France;1. Medical Intern, Southern Health, Melbourne, Victoria, Australia;2. Oral and Maxillofacial Surgery Unit, Epworth Hospital, Richmond, Victoria, Australia;1. Institute of Head and Neck Studies and Education, University of Birmingham, B15 2TT;2. New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton Road, Wolverhampton, West Midlands, WV10 0QP |
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| Abstract: | BackgroundThe anterolateral thigh myocutaneous flap is one of the most commonly used flaps in reconstructive procedures, but its application in oral and maxillofacial defects has not been fully determined. Herein, we summarize the application of 1212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and examine their benefits in maxillofacial reconstruction of these defects.MethodsPatients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Patient ages ranged from 6 to 82 years with a mean age of 51.2 years. There are 1015 flaps showing single lobe and 197 flaps showing a multi-island pedicle and one of which carries the iliac bone. The largest area among the single flaps was 28 × 12 cm2, and the smallest was 3 × 2 cm2.ResultsAmong the 1212 transferred flaps, 1176 survived and 36 showed necrosis, a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing (10.1%), localized paraesthesia (50.1%), and altered quadriceps force (11.0%). No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time (23–121 min; average 51 min) for anastomosis of one vein and one artery was significantly less than that for two veins and one artery (45–153 min, average 83 min; p = 0.0003), which indicates one vein anastomosis can significantly reduce the operating time.ConclusionThe anterolateral thigh myocutaneous flaps can be easily obtained and can provide a good amount of muscle for filling dead space and fascia lata. These flaps can be prepared into a separate fat flap, multi-island fascia with iliac bone, and other composite pedicle flaps to meet the various requirements of oral and maxillofacial defects. The subcutaneous fat thickness of the anterolateral area can vary considerably and thus can be used to repair defects requiring different flap thickness. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps. |
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| Keywords: | Anterolateral thigh myocutaneous flap Oral and maxillofacial defects Oral cancer Reconstruction |
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