Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction |
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| Institution: | 1. Department of Oral Maxillofacial–Head Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China;2. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China;3. Department of Otolaryngology–Head and Neck Surgery, Geisinger Medical Center, Danville, PA, USA;4. Department of CT Clinical Research, CT Business Unit, Canon Medical Systems (China) Co., Ltd, Beijing, China;1. Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain;2. Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain;1. Department of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. College of Stomatology, Shanghai Jiao Tong University, School of Medicine, Shanghai, China;3. Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, Shanghai, China;4. Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt;1. Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA;2. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;3. Division of Hematology–Oncology, Cancer and Blood Disease Institute, Children''s Hospital Los Angeles, Los Angeles, CA, USA;4. Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA;1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China;2. Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China |
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| Abstract: | The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149–336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314–142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects. |
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| Keywords: | Perforator flap Neck muscles Myocutaneous flap Mouth neoplasms Reconstructive surgical procedures Complications Treatment outcome |
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