Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , ZHANG Yixin ² , PENG Xiaowei ¹ , ZHOU Bo ¹ , LÜ Chunliu ¹ , PENG Cuie ¹ , PENG Wen ¹ , OU Yan ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Hunan Provincial Oncologic Plastic Surgery Clinical Research Center, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, the Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Oral cancer; through-and-through defect; anterolateral thigh perforator flap; flap transplantation

DOI：

10.7507/1002-1892.201708110

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ObjectiveTo investigate the effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect following oral cancer ablation.MethodsBetween January 2008 and December 2016, 42 patients with oral cancer were treated. There were 31 males and 11 females with an average age of 44.5 years (range, 31-68 years). There were 28 cases of buccal mucosa carcinoma, 10 cases of basal cell carcinoma of buccal skin, 3 cases of gingiva carcinoma, and 1 case of recurrent parotidduct carcinoma. The disease duration ranged from 1 to 24 months (mean, 13.5 months). The size of through-and-through maxillofacial defect ranged from 6.0 cm×4.5 cm to 9.0 cm×7.0 cm. All defects were repaired with the bipaddled anterolateral thigh perforator flap. The paddles were adjusted to repair the buccal area. And the size of flap ranged from 7 cm×5 cm to 10 cm×8 cm. The donor sites were closed directly.ResultsThe operation time was 4.5-7.5 hours (mean, 5.5 hours). All flaps healed and the wounds of recipient and donor sites healed by first intention. All patients were followed up 9-60 months (mean, 22 months). All patients were satisfied with their facial appearance and the speech function. The range of mouth opening was 3-5 cm. Three patients died of recurrence during the follow-up period and the other patients were alive.ConclusionThe bipaddled anterolateral thigh perforator flap is flexible and reliable for the through-and-through maxillofacial defect reconstruction following oral cancer ablation.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, LÜ Chunliu, PENG Cuie, PENG Wen, OU Yan. Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 607-611. doi: 10.7507/1002-1892.201708110 Copy

1.	Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg, 2006, 64(3): 495-502.
2.	Zou H, Zhang WF, Han QB, et al. Salvage reconstruction of extensive recurrent oral cancer defects with the pectoralis major myocutaneous flap. J Oral Maxillofac Surg, 2007, 65(10): 1935-1939.
3.	Levis C, Hynes N, Archibald S. Through and through defects of the lower face. Clin Plast Surg, 2005, 32(3): 327-37.
4.	Thorwarth M, Eulzer C, Bader R, et al. Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg, 2008, 12(3): 113-124.
5.	Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
6.	Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2230.
7.	Kuo YR, Seng-Feng J, Kuo FM, et al. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg, 2002, 48(2): 161-166.
8.	Saint-Cyr M, Schaverien M, Wong C, et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg, 2009, 123(4): 1245-1255.
9.	Boyapati RP, Shah KC, Flood V, et al. Quality of life outcome measures using UW-QOL questionnaire v4 in early oral cancer/squamous cell cancer resections of the tongue and floor of mouth with reconstruction solely using local methods. Br J Oral Maxillofac Surg, 2013, 51(6): 502-507.
10.	Blackwell KE, Buchbinder D, Biller HF, et al. Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck, 1997, 19(7): 620-628.
11.	Chandu A, Sun KC, DeSilva RN, et al. The assessment of quality of life in patients who have undergone surgery for oral cancer: a preliminary report. J Oral Maxillofac Surg, 2005, 63(11): 1606-1612.
12.	Ahmad QG, Navadgi S, Agarwal R, et al. Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg, 2006, 59(2): 166-173.
13.	Hsing CY, Wong YK, Wang CP, et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients—a quality of life analysis. Oral Oncol, 2011, 47(6): 522-527.
14.	宋达疆, 李赞, 周晓, 等. 游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(2): 222-226.
15.	Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
16.	Kang SH, Nam W, Cha IH, et al. Double continuous radial forearm flap for the reconstruction of full-thickness buccal cheek defect. J Plast Reconstr Aesthet Surg, 2009, 62(5): e95-96.
17.	Wei FC, Demirkan F, Chen HC, et al. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg, 1999, 103(1): 39-47.
18.	Liu F, Dong J, Wang T, et al. Reconstruction of through-and-through facial defects with combined anterior tibial flap and dorsalis pedis flap. J Craniofac Surg, 2012, 23(3): 851-855.
19.	Koshima I, Yamamoto H, Hosoda M, et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg, 1993, 92(3): 411-420.
20.	Liu WC, Yang KC. One-stage through-and-through cheek, lips, and oral commissure reconstruction using a double-paddle peroneal chimeric flap: An innovative method. Head Neck, 2015, 37(5): 662-669.
21.	Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.

1. Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg, 2006, 64(3): 495-502.
2. Zou H, Zhang WF, Han QB, et al. Salvage reconstruction of extensive recurrent oral cancer defects with the pectoralis major myocutaneous flap. J Oral Maxillofac Surg, 2007, 65(10): 1935-1939.
3. Levis C, Hynes N, Archibald S. Through and through defects of the lower face. Clin Plast Surg, 2005, 32(3): 327-37.
4. Thorwarth M, Eulzer C, Bader R, et al. Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg, 2008, 12(3): 113-124.
5. Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
6. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2230.
7. Kuo YR, Seng-Feng J, Kuo FM, et al. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg, 2002, 48(2): 161-166.
8. Saint-Cyr M, Schaverien M, Wong C, et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg, 2009, 123(4): 1245-1255.
9. Boyapati RP, Shah KC, Flood V, et al. Quality of life outcome measures using UW-QOL questionnaire v4 in early oral cancer/squamous cell cancer resections of the tongue and floor of mouth with reconstruction solely using local methods. Br J Oral Maxillofac Surg, 2013, 51(6): 502-507.
10. Blackwell KE, Buchbinder D, Biller HF, et al. Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck, 1997, 19(7): 620-628.
11. Chandu A, Sun KC, DeSilva RN, et al. The assessment of quality of life in patients who have undergone surgery for oral cancer: a preliminary report. J Oral Maxillofac Surg, 2005, 63(11): 1606-1612.
12. Ahmad QG, Navadgi S, Agarwal R, et al. Bipaddle pectoralis major myocutaneous flap in reconstructing full thickness defects of cheek: a review of 47 cases. J Plast Reconstr Aesthet Surg, 2006, 59(2): 166-173.
13. Hsing CY, Wong YK, Wang CP, et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients—a quality of life analysis. Oral Oncol, 2011, 47(6): 522-527.
14. 宋达疆, 李赞, 周晓, 等. 游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效观察. 中国修复重建外科杂志, 2017, 31(2): 222-226.
15. Zhang YX, Xi W, Lazzeri D, et al. Bipaddle radial forearm flap for head and neck reconstruction. J Craniofac Surg, 2015, 26(2): 350-353.
16. Kang SH, Nam W, Cha IH, et al. Double continuous radial forearm flap for the reconstruction of full-thickness buccal cheek defect. J Plast Reconstr Aesthet Surg, 2009, 62(5): e95-96.
17. Wei FC, Demirkan F, Chen HC, et al. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg, 1999, 103(1): 39-47.
18. Liu F, Dong J, Wang T, et al. Reconstruction of through-and-through facial defects with combined anterior tibial flap and dorsalis pedis flap. J Craniofac Surg, 2012, 23(3): 851-855.
19. Koshima I, Yamamoto H, Hosoda M, et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg, 1993, 92(3): 411-420.
20. Liu WC, Yang KC. One-stage through-and-through cheek, lips, and oral commissure reconstruction using a double-paddle peroneal chimeric flap: An innovative method. Head Neck, 2015, 37(5): 662-669.
21. Marsh DJ, Chana JS. Reconstruction of very large defects: a novel application of the double skin paddle anterolateral thigh flap design provides for primary donor-site closure. J Plast Reconstr Aesthet Surg, 2010, 63(1): 120-125.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of bipaddled anterolateral thigh perforator flap in repair of through-and-through maxillofacial defect after oral cancer ablation

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