Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study

Abstract

Background: Patients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass. Methods: From August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups. Results: There were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05). Conclusions: The chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects

“…The ALT flap is a perforator and intermittent septocutaneous flap provided by the lateral cutaneous perforator of the descending branch of the LCFA, which is a branch of the deep femoral artery [1,4,17]. The VL muscle is a type I muscle predominantly supplied by the same descending branch of the ALT flap, although it can also be fed by the transverse branches of the LCFA [21,22,33]. This vascular anatomy enables the ALT and VL muscle flaps to be elevated as a chimeric flap.…”

“…Although the ALT/VL muscle chimeric flap has been used to reconstruct extensive hand and neck injuries [21], studies regarding the use of this flap in the reconstruction of large trunk and lower extremity defects are limited.…”

Repair of postoperative defects of oral cancer with submental island flaps based on vascular pedicles of different states: a multicenter retrospective study

“…Tissue flap repair and reconstruction technology play an important role in extended tumor resection, postoperative reconstruction, restoration of oral function, alleviation of physiological, psychological and social impact, and improving quality of life. With the development of head and neck functional surgery, a consensus has been attained on the immediate postoperative repair and reconstruction of oral cancer that free flap can achieve satisfactory appearance reconstruction and functional recovery, and is the primary means for repairing postoperative defects of oral cancer [8][9][10]18 . The high-level technique required for preparation of free flap, the delicate and complicated operation of microvascular anastomosis, the long operation time, the high risk if a vascular crisis occurs, and the perioperative nursing have limited the wide application of free flap 19,20 .…”

Chimeric ALT Perforator-Free Flap with Vastus Lateralis Muscle for the Obliteration of the Intrathoracic Dead Space Post-Pneumonectomy: A Case Report

“…The anterolateral thigh flap (ALT) has been well-known and popularized for its advantages of versatility and low morbidity. The chimeric concept based on the lateral circumflex femoral artery (LCFA) has then been elaborated in the literature for extensive extremity defects and complex head and neck reconstruction [5] [6]. The authors present a case report at The Kenyatta National Hospital (KNH) on the use of a chimeric ALT perforator-free flap with vastus lateralis (VL) muscle for the obliteration of the intrathoracic dead space post pneumonectomy and a cutaneous paddle for the right anterolateral chest wall reconstruction.…”