Application of folded transverse superficial epigastric artery perforator flap for large penetrating defect after buccal carcinoma resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Dong , LIU Chang , LIU Liang ,  ZHANG Kai

Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;

Corresponding author：

ZHANG Kai, Email: zk29788@163.com

Keywords：

Transverse flap; superficial epigastric artery perforator flap; folded flap; buccal carcinoma

DOI：

10.7507/1002-1892.202301011

Video：

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Objective To explore the effectiveness of folded transverse superficial epigastric artery perforator flap in repairing the large penetrating defect after buccal carcinoma resection. Methods Between January 2019 and June 2021, 12 patients with buccal squamous cell carcinoma were treated. There were 6 males and 6 females with an average of 66.9 years (range, 53-79 years). The pathological stage was T3a-T4b, and the preoperative mouth opening was (3.08±0.46) cm. The disease duration ranged from 6 to 24 months, with an average of 15 months. After buccal carcinoma radical resection and neck lymph node dissection, the penetrating defects in size of 8 cm×6 cm to 16 cm×8 cm and in depth of 0.5-1.5 cm were remained. The transverse superficial epigastric artery perforator flap in size of 8 cm×6 cm to 14 cm×8 cm were harvested and folded to repair the penetrating defects. The donor site was sutured directly. Results All 12 skin flaps survived after operation, and the wounds healed by first intention. No internal or external fistula complications occurred. All incisions at the recipient site healed by first intention. All patients were followed up 12-18 months (mean, 14 months). There was no obvious abnormality in the color and texture of the flap, the oral and facial appearances were symmetrical, and there was no obvious swelling in the cheek. At last follow-up, the patient’s mouth opening was (2.89±0.33) cm, which was not significantly different from that before operation (t=1.879, P=0.087). The subjective satisfaction scores of 12 patients were 6-8 points, with an average of 7.3 points. Significant scars remained at the donor site but concealed in location. Conclusion The folded transverse superficial epigastric artery perforator flap can be used as a surgical method for repairing large penetrating defects after the buccal carcinoma resection, with a good recovery of facial appearance and oral function.

Citation： WANG Dong, LIU Chang, LIU Liang, ZHANG Kai. Application of folded transverse superficial epigastric artery perforator flap for large penetrating defect after buccal carcinoma resection. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 601-604. doi: 10.7507/1002-1892.202301011 Copy

1.	Zhou T, Zhang L, Sun G, et al. Ablation of buccal cancer and functionality buccal reconstruction using an individuation anterolateral thigh flap. J Craniofac Surg, 2018, 29(4): e396-e398.
2.	宋达疆, 李赞, 周晓, 等. 游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损. 中国修复重建外科杂志, 2018, 32(5): 607-611.
3.	马治超, 孙黎波, 周航宇, 等. 折叠游离前臂皮瓣修复颊癌术后洞穿性缺损的临床研究. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 1002-1005.
4.	宋梓维, 伋琳, 周航宇, 等. 双皮岛游离前臂皮瓣在腭部大型洞穿性缺损修复中的应用. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1165-1167, 1172.
5.	王栋, 张凯, 徐涛, 等. 数字化三维重建技术辅助腹壁浅动脉皮瓣修复口腔颌面部缺损的应用研究. 中华口腔医学杂志, 2021, 56(3): 263-267.
6.	Jiang Q, Xue D, Xin Y, et al. A competing risk nomogram for predicting cancer-specific death of patients with buccal mucosa cancer. Oral Dis, 2021, 27(4): 900-910.
7.	Riju J, George NA, Krishna J. AJCC 8th versus AJCC 7th as a prognostic indicator in buccal mucosal squamous cell carcinoma. Indian J Surg Oncol, 2023, 14(1): 228-233.
8.	Jimenez AG, Reategui A, Lopez J. The superficial inferior epigastric artery interpolated flap for closure of large anterolateral thigh flap donor site defects. J Craniofac Surg, 2022, 33(3): e341-e342.
9.	Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.
10.	王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
11.	Yoshimatsu H, Hayashi A, Karakawa R, et al. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery, 2020, 40(6): 649-655.
12.	宋达疆, 李赞, 章一新. 股前外侧嵌合穿支肌皮瓣的制备方式及优化策略研究. 中国修复重建外科杂志, 2023, 37(2): 180-184.
13.	Wu X, Yang R, Yuan Y, et al. Application of a chimeric ALT perforator flap with vastus lateralis muscle mass in the reconstruction of the defects after radical resection of a buccal carcinoma: A retrospective clinical study. J Surg Oncol, 2020, 122(4): 632-638.
14.	Sacher M, Kapalschinski RN, Wallner C, et al. Body mass index and abdominal wall thickness correlate with perforator caliber in free abdominal tissue transfer for breast reconstruction. J Plast Reconstr Aesthet Surg, 2020, 73(3): 494-500.
15.	周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
16.	Wang D, Gao T, Liu L, et al. Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue. Br J Oral Maxillofac Surg, 2020, 58(8): 992-996.
17.	Qiao X, Li C, Liu H, et al. Reconstruction of parotid duct defect with autologous vein graft and vascular coupler after buccal mucosa cancer resection. J Stomatol Oral Maxillofac Surg, 2021, 122(6): 608-611.
18.	Bakshi J, Goyal AK, Saini J. Quality of life in oral cancer patients following surgical excision and flap reconstruction. J Maxillofac Oral Surg, 2022, 21(2): 326-331.

1. Zhou T, Zhang L, Sun G, et al. Ablation of buccal cancer and functionality buccal reconstruction using an individuation anterolateral thigh flap. J Craniofac Surg, 2018, 29(4): e396-e398.
2. 宋达疆, 李赞, 周晓, 等. 游离分叶股前外侧穿支皮瓣修复口腔颌面部恶性肿瘤术后颊部洞穿缺损. 中国修复重建外科杂志, 2018, 32(5): 607-611.
3. 马治超, 孙黎波, 周航宇, 等. 折叠游离前臂皮瓣修复颊癌术后洞穿性缺损的临床研究. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 1002-1005.
4. 宋梓维, 伋琳, 周航宇, 等. 双皮岛游离前臂皮瓣在腭部大型洞穿性缺损修复中的应用. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1165-1167, 1172.
5. 王栋, 张凯, 徐涛, 等. 数字化三维重建技术辅助腹壁浅动脉皮瓣修复口腔颌面部缺损的应用研究. 中华口腔医学杂志, 2021, 56(3): 263-267.
6. Jiang Q, Xue D, Xin Y, et al. A competing risk nomogram for predicting cancer-specific death of patients with buccal mucosa cancer. Oral Dis, 2021, 27(4): 900-910.
7. Riju J, George NA, Krishna J. AJCC 8th versus AJCC 7th as a prognostic indicator in buccal mucosal squamous cell carcinoma. Indian J Surg Oncol, 2023, 14(1): 228-233.
8. Jimenez AG, Reategui A, Lopez J. The superficial inferior epigastric artery interpolated flap for closure of large anterolateral thigh flap donor site defects. J Craniofac Surg, 2022, 33(3): e341-e342.
9. Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.
10. 王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
11. Yoshimatsu H, Hayashi A, Karakawa R, et al. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery, 2020, 40(6): 649-655.
12. 宋达疆, 李赞, 章一新. 股前外侧嵌合穿支肌皮瓣的制备方式及优化策略研究. 中国修复重建外科杂志, 2023, 37(2): 180-184.
13. Wu X, Yang R, Yuan Y, et al. Application of a chimeric ALT perforator flap with vastus lateralis muscle mass in the reconstruction of the defects after radical resection of a buccal carcinoma: A retrospective clinical study. J Surg Oncol, 2020, 122(4): 632-638.
14. Sacher M, Kapalschinski RN, Wallner C, et al. Body mass index and abdominal wall thickness correlate with perforator caliber in free abdominal tissue transfer for breast reconstruction. J Plast Reconstr Aesthet Surg, 2020, 73(3): 494-500.
15. 周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
16. Wang D, Gao T, Liu L, et al. Thin superficial inferior epigastric artery perforator flap for reconstruction of the tongue. Br J Oral Maxillofac Surg, 2020, 58(8): 992-996.
17. Qiao X, Li C, Liu H, et al. Reconstruction of parotid duct defect with autologous vein graft and vascular coupler after buccal mucosa cancer resection. J Stomatol Oral Maxillofac Surg, 2021, 122(6): 608-611.
18. Bakshi J, Goyal AK, Saini J. Quality of life in oral cancer patients following surgical excision and flap reconstruction. J Maxillofac Oral Surg, 2022, 21(2): 326-331.

Chinese Journal of Reparative and Reconstructive Surgery

Application of folded transverse superficial epigastric artery perforator flap for large penetrating defect after buccal carcinoma resection

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