Outcome in Patients with Partial and Full-Thickness Cheek Defects following Free Flap Reconstruction—A Multicentric Analysis of 47 Cases

Abstract

The objective of this study was to evaluate whether the extent of tumor resection and free flap reconstruction influences functional outcome and complications in patients with solid malignancies of the cheek. Therefore, we retrospectively assessed recipient site complications and functional outcomes in 47 patients with solid malignancies of the cheek who underwent either partial (n = 30; 63.8%) or full-thickness (n = 17; 36.2%) cheek resection with free flap reconstruction. Complications occurred in 12 (70.6%) patients after full thickness resections with creation of through-and-through defects compared to 14 (70.6%) patients with partial defects (p = 0.138). Among those 26 patients (55.3%), major recipient site complications, like development of salivary fistula or free flap loss, were observed in 10 (21.3%) and 2 (4.3%) cases, respectively, while minor complications, like wound dehiscence and local infections, were found in 14 (29.8%) and 9 (19.1%) patients. Complications were noticed particularly after reconstruction of suborbital defects (69.2%; p = 0.268), of which occurrence of salivary fistulae was the most common (46.2%; p = 0.035). Similarly, functional outcomes including oral incompetence, ectropion, and trismus were not affected by the extent of resection (p = 0.766). However, oral incompetence was higher in patients with tumors originating from the oral cavity (p = 0.020) and after the performance of mandibulectomy (p = 0.003). Overall, there was no difference in functional outcome or recipient site morbidity between tumor resections resulting in full-thickness and partial defects.

Various Types of Facial-Angular Artery-Based Flaps for Reconstructing Oral and Maxillofacial Defects Following Cancer Ablation

“…Retroangular flaps (ipsilateral R-FAAF based on proximal FAVs in this study) may prove useful for the treatment of defects ranging in size from 1.8×1.6 to 3.0×3.0 cm on the lower half of the nose or lower eyelid 22 . Contralateral nasolabial flaps (contralateral R-FAAF in this study) have been used to reconstruct midface defects ranging in size from 5.3 to 31.0 cm 2 after excision of skin tumors, with good functional and esthetic results 23 . In this study, the R-FAAIF was larger than the FAAIF.…”

“…This type of flap is technically simple to use and a good alternative for the reconstruction of moderate to large midfacial through-and-through defects 7 . Although using free flaps for reconstructing full-thickness cheek defects is very common, 23 in patients of advanced age with comorbidities contraindicating free flaps, the contralateral full-thickness type can be used to reconstruct moderate full-thickness cheek defects. In this study, the FAAIF rotation type was used to reconstruct moderate nasal skin defects.…”

Optical coherence tomography for in vivo longitudinal monitoring of artificial dermal scaffold

“…1 Skin loss is one of the common skin damages and to date, can be treated with surgical grafting methods, that is, skin grafts 2,3 and flaps. 4,5 For example, skin grafts can be used for treating traumatic wounds, defects after oncologic resection, congenital skin deficiencies, vitiligo, and so on. Flaps are used preferentially for wounds with deep depth and bone exposed.…”

“…Serious skin damage can cause skin scar, dehydration, fatal infection, and death 1 . Skin loss is one of the common skin damages and to date, can be treated with surgical grafting methods, that is, skin grafts 2,3 and flaps 4,5 . For example, skin grafts can be used for treating traumatic wounds, defects after oncologic resection, congenital skin deficiencies, vitiligo, and so on.…”