Multiple Free Flap Reconstruction of a Complex Intraoral Defect after Squamous Cell Carcinoma Excision: A Case Report

Abstract

Background: Squamous cell carcinoma is the most frequent malignant cancer of the oral cavity. Metastasis involvement is one of the most relevant prognostic factors in terms of survival probability. Patients with oral cancers often undergo extensive en bloc resective surgery of the mandible and maxilla, with or without cervical nodal dissection, based on the presence or occult risk of regional metastases. Several factors affect the choice of flap, to recover aesthetics and function. Case Presentation: The case of a 60-year-old man who underwent maxillectomy with neck dissection as well as a reconstruction with a combination of multiple vascularized free flaps is presented. Conclusions: The excellent integration of the free flaps and the total absence of complications led to a high-quality aesthetic and functional performance of the reconstruction obtained through two different flaps. More specifically, the fibular free flap for bone reconstruction allows a two-team approach and maintains an excellent vascularization, even in case of several osteotomies for the maxillary reconstruction as reported. In addition, the use of free radial forearm flap for soft tissue reconstruction permits to obtain long caliber vessels, thus facilitating surgery without repositioning of the patient during surgery and therefore, consequently reducing surgery times.

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series

“…Consequently, the combination of multiple flaps has emerged as an innovative therapeutic approach (Lee et al, 2010;Weitz et al, 2015;Hsieh and Bewley, 2019;Silva et al, 2019;Moratin et al, 2021;Raghuram et al, 2021;Santilli et al, 2021;Tharakan et al, 2023). The ALT can furnish sufficient tissue volume and can be fashioned into a chimeric flap with minimal impact on the donor site, rendering it an Frontiers in Bioengineering and Biotechnology frontiersin.org optimal choice for repair and reconstruction of large soft tissue defects in the oromandibular region (Thomas et al, 2020).…”

Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study

“…Studies have shown that surgical management is one of the primary treatment modalities necessary for achieving optimal survival outcomes in patients with oral cancer [ 2 , 3 ]. The principal surgical treatment for advanced oral cancer is en bloc cancer resection; however, thorough resection leaves a significant defect that has a substantial impact on the intricate structures and functions of the oral and maxillofacial areas [ 4 , 5 ]. Moreover, extensive resection might cause malformation, disfigurement, and dysfunction [ 6 ].…”