Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONGDajiang ¹ ,  LIZan ¹ , ZHOUXiao ¹ , ZHANGYixin ² , XIESonglin ³ , PENGXiaowei ¹ , ZHOUBo ¹ , LÜChunliu ¹ , YANGLichang ¹ , PENGWen ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200011, P.R.China;
3. Department of Hand and Foot Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang Hunan, 421000, P.R.China;

Corresponding author：

LIZan, Email: zzanli@163.com

Keywords：

Thoracoacromial artery perforator flap; free flap; tongue carcinoma; tongue reconstruction

DOI：

10.7507/1002-1892.201609090

Video：

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Objective To investigate the clinical outcome of free thoracoacromial artery perforator (TAAP) flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control (UICC) TNM stage, 3 cases were classified as T₄N₀M₀, 3 cases as T₄N_lM₀, 2 cases as T₃N₁M₀, 2 cases as T₃N₂M₀, and 1 case as T₃N₀M₀. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm×3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm (0.8 cm on average) in thickness, with a pedicle length of 6.8-9.9 cm (7.2 cm on average). Results All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months (17.2 months on average). The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Conclusion The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.

Citation： SONGDajiang, LIZan, ZHOUXiao, ZHANGYixin, PENGXiaowei, ZHOUBo, LVChunliu, YANGLichang, PENGWen. Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 222-226. doi: 10.7507/1002-1892.201609090 Copy

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2.	Hanasono MM, Matros E, Disa JJ. Important aspects of head and neck reconstruction. Plast Reconstr Surg, 2014, 134(6): 968e-980e.
3.	Brown JS, Rogers SN, Lowe D. A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg, 2006, 35(3): 208-214.
4.	Broyles JM, Abt NB, Shridharani SM, et al. The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach. Plast Reconstr Surg, 2014, 134(4): 760-769.
5.	Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck, 2004, 26(12): 1038-1044.
6.	Katou F, Shirai N, Kamakura S, et al. Intraoral reconstruction with innervated forearm flap: a comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 80(6): 638-644.
7.	Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
8.	Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg, 1979, 63(1): 73-81.
9.	周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 2001, 10(12): 694-695.
10.	高银光, 范飞, 尤建军, 等. 颏下皮瓣的应用解剖学研究. 中国临床解剖学杂志, 2006, 24(1): 54-56.
11.	Forner D, Phillips T, Rigby M, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg, 2016, 45: 11.
12.	Chaudhary B, Gong Z, Ling B, et al. Application of the submental island flap in the reconstruction of intraoral defects. J Craniofac Surg, 2014, 25(4): e309-312.
13.	Kuriakose MA, Loree TR, Spies A, et al. Sensate radial forearm free flaps in tongue reconstruction. Arch Otolaryngol Head Neck Surg, 2001, 127(12): 1463-1466.
14.	Loewen IJ, Boliek CA, Harris J, et al. Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck, 2010, 32(1): 85-95.
15.	徐达传, 阮默, 张春, 等. 股前外侧部皮瓣的进一步解剖学研究——高位皮动脉与皮瓣血供的分型. 中国临床解剖学杂志, 2002, 20(6): 410-413.
16.	Longo B, Pagnoni M, Ferri G, et al. The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Plast Reconstr Surg, 2013, 132(3): 656-665.
17.	Cheng N, Shou B, Zheng M, et al. Microneurovascular transfer of the tensor fascia lata musculocutaneous flap for reconstruction of the tongue. Ann Plast Surg, 1994, 33(2): 136-141.
18.	Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2016, 126(6): 1315-1320.
19.	Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7): 497-503.
20.	Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5): 759e-770e.

1. Bokhari WA, Wang SJ. Tongue reconstruction: recent advances. Curr Opin Otolaryngol Head Neck Surg, 2007, 15(4): 202-207.
2. Hanasono MM, Matros E, Disa JJ. Important aspects of head and neck reconstruction. Plast Reconstr Surg, 2014, 134(6): 968e-980e.
3. Brown JS, Rogers SN, Lowe D. A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes. Int J Oral Maxillofac Surg, 2006, 35(3): 208-214.
4. Broyles JM, Abt NB, Shridharani SM, et al. The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach. Plast Reconstr Surg, 2014, 134(4): 760-769.
5. Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck, 2004, 26(12): 1038-1044.
6. Katou F, Shirai N, Kamakura S, et al. Intraoral reconstruction with innervated forearm flap: a comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 80(6): 638-644.
7. Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
8. Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg, 1979, 63(1): 73-81.
9. 周晓, 胡炳强, 罗以. 浅谈肿瘤整形外科形成的必要性. 中国肿瘤, 2001, 10(12): 694-695.
10. 高银光, 范飞, 尤建军, 等. 颏下皮瓣的应用解剖学研究. 中国临床解剖学杂志, 2006, 24(1): 54-56.
11. Forner D, Phillips T, Rigby M, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis. J Otolaryngol Head Neck Surg, 2016, 45: 11.
12. Chaudhary B, Gong Z, Ling B, et al. Application of the submental island flap in the reconstruction of intraoral defects. J Craniofac Surg, 2014, 25(4): e309-312.
13. Kuriakose MA, Loree TR, Spies A, et al. Sensate radial forearm free flaps in tongue reconstruction. Arch Otolaryngol Head Neck Surg, 2001, 127(12): 1463-1466.
14. Loewen IJ, Boliek CA, Harris J, et al. Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck, 2010, 32(1): 85-95.
15. 徐达传, 阮默, 张春, 等. 股前外侧部皮瓣的进一步解剖学研究——高位皮动脉与皮瓣血供的分型. 中国临床解剖学杂志, 2002, 20(6): 410-413.
16. Longo B, Pagnoni M, Ferri G, et al. The mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Plast Reconstr Surg, 2013, 132(3): 656-665.
17. Cheng N, Shou B, Zheng M, et al. Microneurovascular transfer of the tensor fascia lata musculocutaneous flap for reconstruction of the tongue. Ann Plast Surg, 1994, 33(2): 136-141.
18. Zhang YX, Li Z, Grassetti L, et al. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope, 2016, 126(6): 1315-1320.
19. Li Z, Cui J, Zhang YX, et al. Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction. J Reconstr Microsurg, 2014, 30(7): 497-503.
20. Zhang YX, Yongjie H, Messmer C, et al. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg, 2013, 131(5): 759e-770e.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma

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