Clinical application of various forms of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in defect reconstruction after tongue carcinoma resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , XIE Songlin ² , WU Jiao ³ , LIU Zhizhong ⁴ , PENG Wen ¹ , OU Yan ¹ , LI Xiaohui ¹ , LIU Zeyang ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410008, P.R.China;
2. Hand Surgical Centre, Nanhua Hospital, Nanhua University, Hengyang Hunan, 421001, P.R.China;
3. Department of Anesthesiology, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410008, P.R.China;
4. Department of Urology Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410008, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Profunda femoral artery; chimeric myocutaneous perforator flap; free flap transplantation; tongue carcinoma; tongue reconstruction

DOI：

10.7507/1002-1892.201701045

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ObjectiveTo investigate the clinical anatomy and application of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in the defect reconstruction after radical resection of tongue carcinoma. MethodsBetween April 2011 and January 2016, 44 cases of tongue carcinoma underwent radical resection, and tongue defects were reconstructed by free profunda femoral artery pedicled chimeric myocutaneous perforator flaps at the same stage. There were 40 males and 4 females, with a mean age of 46.3 years (range, 32-71 years). The pathologic type was squamous cell carcinoma, which involved the lingual margin in 24 cases, the ventral tongue in 17 cases, and the mouth floor in 3 cases. According to Union for International Cancer Control (UICC) TNM staging, 16 cases were rated as T₄N₀M₀, 11 cases as T₄N₁M₀, 9 cases as T₃N₁M₀, and 8 cases as T₃N₂M₀. The course of disease ranged from 1 to 22 months (mean, 8.6 months). The size of perforator flap ranged from 8.5 cm×4.0 cm to 12.0 cm×6.5 cm, and the size of muscle flap ranged from 4.0 cm×3.0 cm to 7.5 cm×5.0 cm. The adductor magnus myocutaneous flap with a pedicle of (8.3±0.5) cm was used in 11 cases, and the gracilis muscle myocutaneous flap with a pedicle of (8.1±0.8) cm was used in 33 cases. The donor sites were sutured directly. ResultsAll 44 perforator flaps survived uneventfully, and the donor site healed well. The patients were followed up for 12 to 40 months (mean, 23.8 months). The reconstructed tongue had good appearance and function in swallowing and language. No local recurrence was found. Only linear scar was left at the donor sites. ConclusionThe free profunda femoral artery pedicled chimeric myocutaneous perforator flap can be harvested in various forms, and is an ideal choice to reconstruct defect after radical resection of tongue carcinoma.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, XIE Songlin, WU Jiao, LIU Zhizhong, PENG Wen, OU Yan, LI Xiaohui, LIU Zeyang. Clinical application of various forms of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in defect reconstruction after tongue carcinoma resection. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 696-701. doi: 10.7507/1002-1892.201701045 Copy

1.	Lawson BR, Moreno MA. Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations. Otolaryngol Head Neck Surg, 2016, 154(1): 59-65.
2.	Koshima I. Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
3.	Potter JK, Lee MR, Oxford L, et al. Proximal peroneal perforator in dual-skin paddle configuration of fibula free flap for composite oral reconstruction. Plast Reconstr Surg, 2014, 133(6): 1485-1492.
4.	Chang CC, Huang WC, Lin JY, et al. Perforator flap from proximal lateral leg for head and neck reconstruction. J Reconstr Microsurg, 2013, 29(4): 263-270.
5.	Hallock GG. The buttock crease adductor magnus peninsular perforator flap as another local flap option for repair of the ischial pressure sore transverse adductor magnus flap. Plast Reconstr Surg, 2013, 132(1): 183e-184e.
6.	Allen RJ Jr, Lee ZH, Mayo JL, et al. The Profunda Artery Perforator Flap Experience for Breast Reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
7.	周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任,更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
8.	Shieh SJ, Chiu HY, Yu JC, et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
9.	Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
10.	Wu JC, Huang JJ, Tsao CK, et al. Comparison of Posteromedial Thigh Profunda Artery Perforator Flap and Anterolateral Thigh Perforator Flap for Head and Neck Reconstruction. Plast Reconstr Surg, 2016, 137(1): 257-266.
11.	Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg, 2001, 107(7): 1725-1731.
12.	Hurwitz ZM, Montilla R, Dunn RM, et al. Adductor magnus perforator flap revisited: an anatomical review and clinical applications. Ann Plast Surg, 2011, 66(5): 438-443.
13.	Chaput B, Eburdery H, Laguerre J, et al. Chimeric flap and free-style puzzle flap for extended coverage of the foot and ankle. Plast Reconstr Surg, 2015, 135(4): 797e-799e.
14.	Simsek T, Engin MS, Yildirim K, et al. Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap. J Craniofac Surg, 2017, 28(3): 638-642.
15.	Fricke A, Rassner M, Kiefer J, et al. Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap. J Reconstr Microsurg, 2017. [Epub ahead of print].
16.	Maldonado AA, Kircher MF, Spinner RJ, et al. Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury. Plast Reconstr Surg, 2016, 138(3): 483e-488e.
17.	Park JE, Chang DW. Advances and Innovations in Microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.

1. Lawson BR, Moreno MA. Head and Neck Reconstruction with Chimeric Anterolateral Thigh Free Flap: Indications, Outcomes, and Technical Considerations. Otolaryngol Head Neck Surg, 2016, 154(1): 59-65.
2. Koshima I. Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
3. Potter JK, Lee MR, Oxford L, et al. Proximal peroneal perforator in dual-skin paddle configuration of fibula free flap for composite oral reconstruction. Plast Reconstr Surg, 2014, 133(6): 1485-1492.
4. Chang CC, Huang WC, Lin JY, et al. Perforator flap from proximal lateral leg for head and neck reconstruction. J Reconstr Microsurg, 2013, 29(4): 263-270.
5. Hallock GG. The buttock crease adductor magnus peninsular perforator flap as another local flap option for repair of the ischial pressure sore transverse adductor magnus flap. Plast Reconstr Surg, 2013, 132(1): 183e-184e.
6. Allen RJ Jr, Lee ZH, Mayo JL, et al. The Profunda Artery Perforator Flap Experience for Breast Reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
7. 周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任,更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
8. Shieh SJ, Chiu HY, Yu JC, et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
9. Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
10. Wu JC, Huang JJ, Tsao CK, et al. Comparison of Posteromedial Thigh Profunda Artery Perforator Flap and Anterolateral Thigh Perforator Flap for Head and Neck Reconstruction. Plast Reconstr Surg, 2016, 137(1): 257-266.
11. Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg, 2001, 107(7): 1725-1731.
12. Hurwitz ZM, Montilla R, Dunn RM, et al. Adductor magnus perforator flap revisited: an anatomical review and clinical applications. Ann Plast Surg, 2011, 66(5): 438-443.
13. Chaput B, Eburdery H, Laguerre J, et al. Chimeric flap and free-style puzzle flap for extended coverage of the foot and ankle. Plast Reconstr Surg, 2015, 135(4): 797e-799e.
14. Simsek T, Engin MS, Yildirim K, et al. Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap. J Craniofac Surg, 2017, 28(3): 638-642.
15. Fricke A, Rassner M, Kiefer J, et al. Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap. J Reconstr Microsurg, 2017. [Epub ahead of print].
16. Maldonado AA, Kircher MF, Spinner RJ, et al. Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury. Plast Reconstr Surg, 2016, 138(3): 483e-488e.
17. Park JE, Chang DW. Advances and Innovations in Microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of various forms of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in defect reconstruction after tongue carcinoma resection

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