Reconstruction of large composite buccal defects using single soft tissue flap—analysis of functional outcome

Abstract

Resection of advanced gingivo-buccal tumors results in a posterolateral mandibular and large soft tissue defect. Because of large soft tissue requirement, these defects are difficult to reconstruct using a single osteocutaneous flap. A double free flap reconstruction of such defects is recommended. However, double flap may not be feasible in certain situations. In this study, we objectively evaluated functional and cosmetic outcomes following single soft-tissue flap reconstruction in a group of patients where double flap reconstruction was not feasible. Patient and defect characteristics were obtained from charts. The speech and swallowing functions of patients were prospectively assessed by a dedicated therapist. The cosmetic outcome of reconstruction was evaluated by an independent observer. Fifty-six patients with large soft tissue and segmental posterolateral mandible defect, reconstructed with anterolateral thigh or pectoralis major flap from May 2009 till December 2010 were included. In this series, none of the flaps were lost; two patients with pectoralis major flap developed partial skin paddle loss. Most of the patients developed mandibular drift; however, majority of these patients had no postoperative trismus. All patients resumed regular or soft solid oral diet. The mean speech intelligibility was more than 70%. Majority of patients had satisfactory cosmetic outcome. The defects were classified into regions resected to develop a reconstruction algorithm for optimal reconstruction using a free or pedicle flap. In conclusion, patients with large oro-mandibular defect undergoing single soft tissue flap reconstruction have satisfactory functional and cosmetic outcome.

Early Modification in Drainage of Interleukin-1β and Tumor Necrosis Factor-α Best Predicts Surgical-Site Infection After Cervical Neck Dissection for Oral Cancer

“…18 For larger tumors, such as HNSCC stage T3 and T4, pedicled flaps (eg, pectoralis major flap, temporal myofascial flap, or cervicothoracic flap) or microvascular flaps (eg, ALT flap, fibula flap, radial forearm flap, and medial sural flap) are used for the reconstruction of postsurgical defects. 19,20 None of the patients with isolated CND developed an SSI.…”

Versatility of Adipofascial Anterolateral Thigh Flap for Reconstruction of Maxillary Defects with Infratemporal Fossa Extension

“…Inadequate substitution of soft tissue may result in trismus. 6 In such situations, reconstruction with a RFFF or obturator is inadequate. RFFF may not provide enough soft tissue to obliterate the ITF cavity.…”

“…Such a cavity could heal with fibrosis resulting in trismus. 6 Anterolateral thigh flap (ALT) or rectus abdominis myocutaneous flap may be used, however, these flaps have a bulky oral component and tend to have a delayed flap mucosalization, thereby adversely affecting the functional outcome.…”

A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery

“…Patient opinions are most important for bone flaps because of the greater donor site morbidity and lower success rates (93%). A PPM flap provides reasonable mandibular function in the context of limited longevity and without a reconstruction plate that is often compromised by complications. Hsing et al .…”