COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANGHeping , ZHANGHongwu , CHENHaidi , YANGShuxiong , WANGJun , HUDawang

Department of Oral and Maxillofacial Surgery, the Xiangtan City Central Hospital, Xiangtan Hunan, 411100, P. R. China;

Corresponding author：

YANGHeping, Email: yangheping314@sina.com

Keywords：

Chimeric anterolateral thigh flap; Series-wound flaps; Oral and maxillofacial cancer; Defect reconstruction

DOI：

10.7507/1002-1892.20160090

Video：

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Objective To compare the effectiveness of complex defects repair between using chimeric anterolateral thigh flap and series-wound flaps after resection of oral and maxillofacial cancer. Method After resection of oral and maxillofacial cancer, defect was repaired with chimeric anterolateral thigh flap in 39 patients between January 2011 and July 2014 (chimeric anterolateral thigh flap group); and defect was repaired with series-wound flaps in 35 patients between January 2009 and December 2010 (series-wound flaps group). There was no significant difference in gender, age, duration of disease, tumor type, tumor staging, defect location, and defect area between 2 groups (P>0.05) . The operation time, flap harvesting and microvascular anastomosis time, stomach tube extraction time, and oral feeding time were recorded and compared between 2 groups, and postoperative complications were observed; the effectiveness was evaluated according to clinical efficacy evaluation table of bone and soft tissue defects reconstruction surgery in oral and maxillofacial region. Results Vascular crisis occurred in 2 cases of chimeric anterolateral thigh flap group, and 4 cases of series-wound flaps group. Partial necrosis appeared at distal end of a series-wound flaps, and oral fistula and infection developed in 3 series-wound flaps. The other flaps and the grafted skin at donor site survived; wounds at recipient site healed by first intention. The operation time, stomach tube extraction time, and oral feeding time of chimeric anterolateral thigh flap group were significantly shorter than those of series-wound flaps group (P<0.05) , while the flap harvesting and microvascular anastomosis time was significantly longer than that of series-wound flaps group (P<0.05) . The patients were followed up 1-5 years (mean, 2.5 years). At 3 months after operation, the appearance, patients' satisfaction, working conditions, oral closure function, chew, language performance, and swallowing scores of the chimeric anterolateral thigh flap group were significantly better than those of the series-wound flaps group (P<0.05) , while there was no significant difference in diet, mouth opening degree, oral cavity holding water test, and occlusion scores between the 2 groups (P>0.05) . Conclusions Using chimeric anterolateral thigh flap for defect repair after resection of oral and maxillofacial cancer can significantly shorten the operation time, accelerate postoperative rehabilitation, and help the functional recovery of oral closure, chewing, language performance, swallowing function when compared with the series-wound flaps.

Citation： YANGHeping, ZHANGHongwu, CHENHaidi, YANGShuxiong, WANGJun, HUDawang. COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(4): 447-452. doi: 10.7507/1002-1892.20160090 Copy

1.	魏在荣. 影响皮瓣成活的血管因素分析. 中国美容整形外科杂志, 2014, 25(3) :129-131.
2.	王金龙, 徐斌, 王兵, 等. 髂腹股沟皮瓣联合带蒂股前外侧皮瓣修复手部大面积皮肤缺损. 重庆医学, 2013, 42(2) :197-198.
3.	陈睿, 李雯娟, 杨凯, 等. 股前外侧皮瓣在口腔颌面外科的临床应用. 重庆医科大学学报, 2014, 39(8) :1160-1162.
4.	徐立群, 张陈平, 张志愿, 等. 血管化游离组织瓣在口腔颌面-头颈部缺损修复中的应用(4640例临床分析). 实用肿瘤杂志, 2015, 30(1) :18-21.
5.	雷林革, 袁崇喜, 何如祥, 等. 游离股前外筋膜瓣修复手部软组织缺损. 实用手外科杂志, 2013, 27(2) :118-120.
6.	Yamada S, Okamoto H, Sekiya I, et al. Anatomical basis of distally based anterolateral thigh flap. J Plast Surg Hand Surg, 2014, 48(3) :197-200.
7.	Wei ZR, Sun GF, Wang DL, et al. Reconstruction of the Achilles tendon and overlying skin defect:3 case reports. Ann Plast Surg, 2014, 73(3) :325-329.
8.	Zhuang Y, Hu S, Wu D, et al. A novel in vivo technique for observations of choke vessels in a rat skin flap model. Plast Reconstr Surg, 2012, 130(2) :308-317.
9.	Ao M, Asagoe K, Maeta M. Combined anterior thigh flaps and vascularized fibular graft for reconstruction of massive composite oromandibular defects. Br J Plast Surg, 1998, 51(5) :350-355.
10.	Singh B, Cordeiro PG, Santamaria E, et al. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg, 1999, 103(2) :403-411.
11.	Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9) :759-769.
12.	Rogers SN, Lowe D. The University of Washington Quality of Life Scale//Handbook of Disease Burdens and Quality of Life Measures. New York:Springer, 2010:101-128.
13.	罗瑞华, 齐金星, 赵铭, 等. 削薄股前外侧皮瓣游离移植修复舌癌术后缺损的临床疗效. 武汉大学学报(医学版), 2012, 33(4) :585-586,593.
14.	唐修俊, 魏在荣, 王波, 等. 游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用. 中华显微外科杂志, 2015, 38(1) :29-32.
15.	Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps:an introduction to the chimera flap principle. Ann Plast Surg, 1991, 27(2) :126-131.
16.	杜学亮, 陈平, 杜永军, 等. 串联皮瓣修复大面积颅骨外露. 中国美容医学, 2012, 21(3) :360-362.
17.	徐中飞, 代炜, 张恩礁, 等. 股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损. 上海口腔医学, 2012, 21(1) :107-112.
18.	陈洁, 蒋灿华, 闵安杰, 等. 旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损. 华西口腔医学杂志, 2015, 33(3) :276-280.
19.	Bhadkamkar MA, Wolfswinkel EM, Hatef DA, et al. The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg, 2014, 30(9) :599-606.
20.	Goel S, Arora J, Mehta V, et al. Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications. World J Clin Cases, 2015, 3(1) :85-88.
21.	Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4) :1097-1107.
22.	蔡志刚, 孙坚. 显微外科技术在口腔颌面及头颈部修复与重建中的应用. 中华显微外科杂志, 2014, 37(5) :417-420.
23.	Taylor GI, Gorlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries:developent of the concept and designing safe flap. Plast Resonstr Surg, 2011, 127(4) :1447-1459.
24.	陈丹, 杨凯, 陈睿, 等. 股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的应用. 重庆医科大学学报, 2014, 39(1) :125-126.
25.	肖海涛, 时莹瑜, 王怀胜, 等. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用. 中国修复重建外科杂志, 2013, 27(2) :178-181.
26.	陈洁, 蒋灿华, 尹乒, 等. 股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用. 中华显微外科杂志, 2015, 38(1) :20-24.

1. 魏在荣. 影响皮瓣成活的血管因素分析. 中国美容整形外科杂志, 2014, 25(3) :129-131.
2. 王金龙, 徐斌, 王兵, 等. 髂腹股沟皮瓣联合带蒂股前外侧皮瓣修复手部大面积皮肤缺损. 重庆医学, 2013, 42(2) :197-198.
3. 陈睿, 李雯娟, 杨凯, 等. 股前外侧皮瓣在口腔颌面外科的临床应用. 重庆医科大学学报, 2014, 39(8) :1160-1162.
4. 徐立群, 张陈平, 张志愿, 等. 血管化游离组织瓣在口腔颌面-头颈部缺损修复中的应用(4640例临床分析). 实用肿瘤杂志, 2015, 30(1) :18-21.
5. 雷林革, 袁崇喜, 何如祥, 等. 游离股前外筋膜瓣修复手部软组织缺损. 实用手外科杂志, 2013, 27(2) :118-120.
6. Yamada S, Okamoto H, Sekiya I, et al. Anatomical basis of distally based anterolateral thigh flap. J Plast Surg Hand Surg, 2014, 48(3) :197-200.
7. Wei ZR, Sun GF, Wang DL, et al. Reconstruction of the Achilles tendon and overlying skin defect:3 case reports. Ann Plast Surg, 2014, 73(3) :325-329.
8. Zhuang Y, Hu S, Wu D, et al. A novel in vivo technique for observations of choke vessels in a rat skin flap model. Plast Reconstr Surg, 2012, 130(2) :308-317.
9. Ao M, Asagoe K, Maeta M. Combined anterior thigh flaps and vascularized fibular graft for reconstruction of massive composite oromandibular defects. Br J Plast Surg, 1998, 51(5) :350-355.
10. Singh B, Cordeiro PG, Santamaria E, et al. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg, 1999, 103(2) :403-411.
11. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9) :759-769.
12. Rogers SN, Lowe D. The University of Washington Quality of Life Scale//Handbook of Disease Burdens and Quality of Life Measures. New York:Springer, 2010:101-128.
13. 罗瑞华, 齐金星, 赵铭, 等. 削薄股前外侧皮瓣游离移植修复舌癌术后缺损的临床疗效. 武汉大学学报(医学版), 2012, 33(4) :585-586,593.
14. 唐修俊, 魏在荣, 王波, 等. 游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用. 中华显微外科杂志, 2015, 38(1) :29-32.
15. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps:an introduction to the chimera flap principle. Ann Plast Surg, 1991, 27(2) :126-131.
16. 杜学亮, 陈平, 杜永军, 等. 串联皮瓣修复大面积颅骨外露. 中国美容医学, 2012, 21(3) :360-362.
17. 徐中飞, 代炜, 张恩礁, 等. 股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损. 上海口腔医学, 2012, 21(1) :107-112.
18. 陈洁, 蒋灿华, 闵安杰, 等. 旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损. 华西口腔医学杂志, 2015, 33(3) :276-280.
19. Bhadkamkar MA, Wolfswinkel EM, Hatef DA, et al. The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg, 2014, 30(9) :599-606.
20. Goel S, Arora J, Mehta V, et al. Unusual disposition of lateral circumflex femoral artery:Anatomical description and clinical implications. World J Clin Cases, 2015, 3(1) :85-88.
21. Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators:vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4) :1097-1107.
22. 蔡志刚, 孙坚. 显微外科技术在口腔颌面及头颈部修复与重建中的应用. 中华显微外科杂志, 2014, 37(5) :417-420.
23. Taylor GI, Gorlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries:developent of the concept and designing safe flap. Plast Resonstr Surg, 2011, 127(4) :1447-1459.
24. 陈丹, 杨凯, 陈睿, 等. 股前外侧皮瓣在口腔颌面部肿瘤术后缺损修复中的应用. 重庆医科大学学报, 2014, 39(1) :125-126.
25. 肖海涛, 时莹瑜, 王怀胜, 等. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用. 中国修复重建外科杂志, 2013, 27(2) :178-181.
26. 陈洁, 蒋灿华, 尹乒, 等. 股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用. 中华显微外科杂志, 2015, 38(1) :20-24.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF REPAIR EFFECT BETWEEN CHIMERIC ANTEROLATERAL THIGH FLAP AND SERIES-WOUND FLAPS FOR DEFECT AFTER RESECTION OF ORAL AND MAXILLOFACIAL CANCER

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