Chimeric Anterolateral Thigh and Rectus Femoris Flaps for Reconstruction of Complex Oral and Maxillofacial Defects.

PURPOSE: Complex oral and maxillofacial defects are continuously a challenge for reconstructive surgeons. This study evaluates the effects of chimeric anterolateral thigh (ALT) and rectus femoris flaps for the reconstruction of such defects. PATIENTS AND METHODS: A retrospective review was performed of 10 patients who underwent reconstruction of oral and maxillofacial defects with chimeric ALT and rectus femoris flaps from October 2014 through August 2016 at the Second Xiangya Hospital. RESULTS: All 10 patients were male, with a mean age of 53.6 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. Salivary fistula occurred in 1 patient, and wound effusion of the thigh occurred in another patient. Gradual wound healing was observed after repeated dressing changes. The patients were followed for approximately 3 to 46 months, the appearance and oral functions were recovered well, and no thigh motor dysfunctions were observed. CONCLUSIONS: Because of the convenient flap design, effective avoidance of recipient site complications, lower donor site morbidity, and acceptable functional and esthetic results, chimeric ALT and rectus femoris flaps are a good choice for the reconstruction of complex oral and maxillofacial defects.

A Novel Method for Reconstruction of the Lower Lip After Lip Cancer Ablation: Double Abbe Flap.

PURPOSE: Repair of large defects caused by lip cancer resection is often a challenge for surgeons. The aim of this study was to explore the treatment and outcomes of lower lip reconstruction with a novel surgical procedure after lip cancer ablation. PATIENTS AND METHODS: We performed a retrospective case-series study involving patients who underwent lower lip cancer resection between January 2014 and December 2017 at the Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University. The shape, volume, and symmetry of the lips were evaluated after the operation. In addition, we classified the large defects of the lower lip and recommended the most appropriate surgical procedures for each type. RESULTS: Seventeen men and two women comprised the study population. The average age of the patients was 63 years (range, 37 to 82 years). All the defects of the lower lip after resection were more than half the lip length. We designed and prepared 2 Abbe flaps located symmetrically at the upper lip to repair the defects of the lower lip, referred to as the "double Abbe flap." The double Abbe flap survived in all patients. The volume, shape, and symmetry of the lips were ideal in most patients, and the degree of mouth opening was acceptable in nearly all patients. CONCLUSIONS: The double Abbe flap is a useful and predictable approach for reconstruction of the lower lip after large-area cancer resection, and it can provide a reference for the repair of lip defects from other causes.

Longitudinal Contraction Venoplasty in Prevention of Internal Jugular Vein Thrombosis After Free Flap Vascular Anastomosis.

PURPOSE: The vascular anastomosis of free flap with the internal jugular vein stump is susceptible to thrombosis, thus resulting in flap compromise or failure. This study aims to explore the method of longitudinal contraction venoplasty in the prevention of internal jugular vein stump thrombosis after free flap vascular anastomosis and its feasibility. PATIENTS AND METHODS: A retrospective review was performed of 16 patients who underwent internal jugular vein resection because of cancer ablation and longitudinal contraction venoplasty to prevent internal jugular vein stump thrombosis after free flap vascular anastomosis from January 2013 through December 2014 at Second Xiangya Hospital. The methods for longitudinal contraction venoplasty and its efficacy are reported. RESULTS: Venous anastomosis of all flaps was performed with the internal jugular vein stump, and single venous anastomosis was made in all cases. Postoperatively, all flaps survived completely, without vascular compromise. All the patients were followed for approximately 9 to 33 months, and they were satisfied with the esthetic and functional results of the donor and recipient sites after reconstruction. CONCLUSIONS: Longitudinal contraction venoplasty may be an effective new method for prevention of internal jugular vein thrombosis after free flap vascular anastomosis.

Application of anteromedial thigh flap for the reconstruction of oral and maxillofacial defects.

PURPOSE: To discuss the vascular anatomy of the anteromedial thigh (AMT) flap and to evaluate the feasibility of the AMT flap for the reconstruction of oral and maxillofacial defects. PATIENTS AND METHODS: A retrospective review was performed of 18 patients who underwent reconstruction of oral and maxillofacial defects with AMT flaps from January 2009 through December 2011 in the Second Xiangya Hospital. Eleven unifoliate AMT flaps were elevated to reconstruct defects of the tongue, soft palate, and floor of the mouth and 7 chimeric anterolateral thigh (ALT) and AMT flaps were harvested to reconstruct through-and-through cheek defects. RESULTS: The flaps were 4 × 6 to 9 × 11 cm(2). All the AMT flaps were nourished by the descending branch (DB) of the lateral circumflex femoral artery. The cutaneous perforators were derived from the rectus femoris branch of the DB in 15 cases and directly from the DB in the other 3 cases. Postoperatively, all flaps survived completely, without major complications. Of the 18 donor sites, 14 were closed directly, leaving only linear scars, and 4 were closed using full-thickness skin grafts owing to larger defects. All patients were followed for approximately 6 to 30 months, and they were satisfied with the esthetic and functional results of the donor and recipient sites after the reconstruction. CONCLUSIONS: Because of easy perforator dissection, the AMT flap can be used as an alternative to the ALT flap or harvested with the ALT flap as chimeric ALT and AMT flaps for the reconstruction of oral and maxillofacial defects.

Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction.

OBJECTIVES: The aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects. PATIENTS AND METHODS: The authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. RESULTS: Of the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. CONCLUSIONS: The FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.

[Clinical analysis of 35 flap crisis in anterolateral thigh free flaps].

UNLABELLED: PURPOSE：The aim of this study was to analyze the causes of anterolateral thigh (ALT) free flap compromise and improve the success rate of ALT. METHODS: Patients were recruited from September 2005 to December 2012 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery using ALT free flaps. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise (i.e. arterial or venous), causes of vascular occlusion and salvage rate. The data was analyzed using SPSS 16.0 software package. RESULTS: There were a total of 812 ALT free flaps transplanted during 7 years. Among the 812 transferred flaps, 794 survived and 18 showed necrosis, the overall survival rate was 97.8%. 35 flap compromises due to vascular obstruction were identified and 18 flaps were salvaged completely after exploration. Venous occlusions occurred in 31 flaps (88.6%) and arterial occlusion in 4 flaps (11.4%). The successful salvage rate within 16 h was significantly higher than those over 16 h (70.6%: 27.8%, P=0.011). The successful salvage rate of venous occlusions was higher than that of arterial occlusion, but there was no significant difference. CONCLUSIONS: Early detection, re-exploration, and effective handling of the flap crisis increase the rate of flap salvage tremendously. Prick test is the gold standard for early detection of flap compromise.

A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation.

BACKGROUND: This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. METHODS: An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. RESULT: Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. CONCLUSION: Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.

[Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects].

OBJECTIVE: To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects. METHODS: Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed. RESULTS: Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. 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 for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05). CONCLUSION: Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.