Chimeric Anterolateral Thigh and Rectus Femoris Flaps for Reconstruction of Complex Oral and Maxillofacial Defects

Abstract

Purpose: Complex oral and maxillofacial defects are continuously a challenge for reconstructive surgeons. This study evaluates the effects of chimeric anterolateral thigh (ALT) and rectus femoris flaps for the reconstruction of such defects. Patients and Methods: A retrospective review was performed of 10 patients who underwent reconstruction of oral and maxillofacial defects with chimeric ALT and rectus femoris flaps from October 2014 through August 2016 at the Second Xiangya Hospital. Results: All 10 patients were male, with a mean age of 53.6 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. Salivary fistula occurred in 1 patient, and wound effusion of the thigh occurred in another patient. Gradual wound healing was observed after repeated dressing changes. The patients were followed for approximately 3 to 46 months, the appearance and oral functions were recovered well, and no thigh motor dysfunctions were observed. Conclusions: Because of the convenient flap design, effective avoidance of recipient site complications, lower donor site morbidity, and acceptable functional and esthetic results, chimeric ALT and rectus femoris flaps are a good choice for the reconstruction of complex oral and maxillofacial defects.

Reconstruction of Complex Lateral Skull Base Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Flap

“…The flaps were harvested simultaneously with tumor ablation and/or neck dissection in two groups, and the methods for flap design and elevation were as previously described ( 4 , 17 ). After sectioning of the skin, subcutaneous fat, and fascia, the lateral and/or medial fascia lata were opened, and sizable cutaneous perforators were explored for the ALT and/or AMT flaps.…”

“…In particular, complex multitissue defects resulting from the radical resection of some recurrent or locally advanced-stage tumors may also involve the lateral skull base. Varying-sized dead spaces are often left in these lateral skull base defects, leading to wound infection or effusion and even more serious complications (4). The reconstruction of such defects remains a reconstructive challenge because of the limited local tissue supply and extremely visible location (5)(6)(7).…”

“…With noticeable advantages and acceptable donor site morbidity, this flap has been increasingly applied in recent years (5,7,(15)(16)(17). The ALT flap is nourished by the lateral circumflex femoral artery (LCFA), and the classic ALT flap or its chimeric flaps are pedicled with the descending branch (DB), the largest and longest branch of the LCFA (4,17). Therefore, various-sized muscles or adipose tissue can be raised simultaneously with the ALT flap, which is crucial for dead space filling and beneficial for wound healing (4).…”

“…In general, surgery is the primary treatment modality in most cases. The wide local excision of tumors often results in large and complex oral and maxillofacial defects, severely damaging the function and appearance and even leading to psychological disorders ( 4 ). In particular, complex multitissue defects resulting from the radical resection of some recurrent or locally advanced-stage tumors may also involve the lateral skull base.…”

“…Several free or pedicle flaps, such as radial forearm flap ( 8 ), latissimus dorsi flap ( 9 ), anterolateral thigh (ALT) flap ( 4 , 10 – 12 ), and pectoralis major flap ( 13 ), have been used to repair oral and maxillofacial soft-tissue defects. Among them, the ALT flap, which was first introduced in 1984 by Song et al.…”