Objective To evaluate the effectiveness of the submental island flap for repair of oral defects after radical resection of early-stage oral squamous cell carcinoma (OSCC). Methods Between February 2010 and August 2011, 15 cases of early-stage OSCC were treated. Of 15 cases, 9 were male and 6 were female, aged from 48 to 71 years (mean, 63 years). The disease duration was 28-73 days (mean, 35 days). Primary lesions included tongue (3 cases), buccal mucosa (8 cases), retromolar area (2 cases), and floor of mouth mucosa (2 cases). According to TNM classification of International Union Against Cancer (UICC, 2002) of oral cancer and oropharyngeal cancer, 2 cases were classified as T1N0M0 and 13 cases as T2N0M0. The results of the pathologic type were high differentiated squamous cell carcinoma in 11 cases and moderately differentiated squamous cell carcinoma in 4 cases. The defect after resection of the lesion ranged from 5 cm × 3 cm to 8 cm × 6 cm. All the cases underwent radical resection of the primary lesion and immediate reconstruction with submental island flap except 1 case with radial forearm free flap because of no definite venous drainage. The sizes of the submental island flap varied from 6 cm × 4 cm to 9 cm × 6 cm. Results Operation time ranged from 4 hours and 30 minutes to 7 hours and 10 minutes (mean, 5 hours and 53 minutes) in 14 cases undergoing repair with submental island flap. All the flaps survived completely in 13 cases except 1 case having superficial necrosis of the flap, which was cured after conservative treatment. Temporary marginal mandibular nerve palsy occurred in 1 case, and was cured after 3 months; submandibular effusion was observed in 3 cases, and was cured after expectant treatment. The follow-up period ranged from 8 to 15 months (mean, 10.5 months) in 14 cases undergoing repair with submental island flap. Hair growth was seen on the flap and became sparse after 3 months in 2 male cases. The appearance of the face, opening mouth, swallowing, and speech were recovered well in 14 cases, and the donor site had no obvious scar. The follow-up period was 13 months in 1 case undergoing repair with radical free forearm flap, and the appearance and function were recovered well. No local recurrence was found during follow-up. Conclusion The submental island flap has reliable blood supply, and could be harvested simply and rapidly. It can be used to repair oral defects in patients with early-stage OSCC after radical resection.
Objective To evaluate the preliminary effect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. Mathods From May 2004 to September 2006, 5 male patients aged 2334 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother’s uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm×3 cm to 9 cm×6 cm. Results All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3patients were satisfied with their good appearance at the operation sites. Conclusion The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.
Objective To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. Methods The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender,disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6.12 was adopted for statistical analysis. Results A total of 1 973reconstructive cases includded 764 in middle age (＞45 years to ≤60 years, 38.72%), 527 in old age (＞60 years, 26.71%), 450 young adults (＞28 years to ≤45 years, 2281%), 187 in young age (＞14 years to ≤28 years, 9.48%) and 45 children(≤14 years, 2.28%). The ratio of male to female was 1.5∶1. The ratio of benign to malignancy lesion was 1∶1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(1738%), parotid defect(13.74%)，buccal defect(12.72%), maxillary defect(8.16%), oral pharynx defect (7.60%), floor of mouth defect(5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(90.4), followed by axial flap(38.17%,753), random flap(10.19%,201), avascularizedbone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1 106/1 973).In 47 free tissue flaps(5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19%(923/940). Conclusion The majority of reconstructive cases of oral and maxillofacial defects is the middle aged andthe old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.
Twohundrednineteen orofaciomaxillary tumours, 18 benigns and 201 malignancies, were repaired by pectoralis major myocutaneous flaps following their resections. The types of flaps used in the repair were: single island myocutaneous flaps in 201 cases, doubleisland myocutaneous flaps in 16 cases, and myocutan eous skeletal flaps in 2 cases. The results were susscessful in 201 cases and failure in 18. The advantages and indications of using pectoralis major myocutaneous flaps were discussed. The method of design and its relevent surgical thechniques were introduced, and the factors responsible for the success and failure were analyzed. It is noted that the correct and meticulous operative techniques were the main factors leading to operative success.
The paper reported the clinical experience of using pectoralis major myocutaneous flap for the immediate repair of massive defects from excising the oral and maxillofacial malignant tumours in 21 cases from 1985 to 1993. The valuation, design, preparation, technique of transfer of the flap and the prevention of flap from necrosis were discussed. It was suggested that the pectoralis major myocutaneous flap was worth using for the immediate repair of massive defects around oral and maxillofacial regions.
目的 探讨股前外侧皮瓣用于修复口腔颌面部缺损的护理方法。 方法 对2011年8月－12月行手术治疗的42例口腔颌面部缺损患者使用股前外侧皮瓣修复，重点加强皮瓣血运的观察和血管危象的处理。 结果 39例皮瓣成活，1例皮瓣坏死；2例出现血管危象，经积极抢救后成活。 结论 股前外侧皮瓣修复口腔颌面部缺损术后加强皮瓣血运的观察和血管危象的处理对保证皮瓣成活至关重要。