Comparison of the reconstruction of through-and-through cheek defects involving the labial commissure following tumor resection using four types of local and pedicle flaps

Abstract

Background The reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge. Methods This study evaluated 35 patients with buccal squamous cell carcinoma (SCC) involving the labial commissure who underwent Abbe–Estlander (A-EF), folded extended supraclavicular fasciocutaneous island (SFIF), folded pectoralis major muscle (PMMF), or folded extended vertical lower trapezius island myocutaneous (TIMF) flap reconstruction of through-and-through cheek defects involving the labial commissure following radical resection. Results The A-EF and SFIF groups differed significantly ( P < 0.05) from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment. The inner PMMF (median 6.3 × 4.5) and TIMF (median 9.8 × 6.7) skin paddle dimensions were larger than those of the A-EF (median 1.8 × 2.2) and SFIF (median 5.5 × 4.3) groups ( P < 0.05). The outer PMMF (median 6.3 × 6.6) and TIMF (median 9.8 × 13.2) dimensions were larger than those of the A-EF (median 1.8 × 3.8) and SFIF (median 5.5 × 4.6) groups ( P < 0.05). The esthetic results, orbicularis oris function, and speech function were significantly ( P < 0.05) better in the A-EF group than in the SFIF, PMMF, and TIMF groups. The patients were followed for 6–38 months (median 26.8, 25.0, 22.1, and 20.8 months in the A-EF, SFIF, PMMF, and TIMF groups, respectively). At the final follow-up, 4 (80.0%) patients in the A-EF, 7 (87.5%) in the SFIF, 5 (55.6%) in the PMMF, and 5 (38.4%) in the TIMF groups were alive with no disease; 1 (20.0%), 1 (22.2%), 2 (22.2%), and 4 (30.8%) patients, respectively, were alive with disease; and 2 (22.2%) patients in the PMMF and 4 (30.8%) in the TIMF group had died of local recurrence or distant metastases at between 9 and 38 months. There was a significant survival difference in the A-EF and SFIF groups compared with the PMMF and TIMF groups ( P < 0.05). Conclusions The A-EF is suitable for reconstructing defects of clinical stage II disease; the SFIF for clinical stage II or III disease; the PMMF for clinical stage III or IV; and the TIMF for clinical stage rCS III or rCS IV disease.

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

“…However, not all patients are suitable for free flap reconstruction, and not all defects require free flap transfer to achieve good functional results 11 . Local and pedicle flaps play important roles in oral and maxillofacial reconstruction, even in the era of free flaps, such as facial-submental artery island, 12–15 supraclavicular artery island, 16,17 and pectoralis major myocutaneous flaps 18–21 …”

Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands

“…There is only little information on clinical consequences of through‐and‐through defects considering morbidity and survival 24 . Some studies investigated surgical techniques considering through‐and‐through defects in BMSCC related to either its resection or the reconstruction 3,25–27 . However, most studies examined extensive defects and none investigated small through‐and‐through defects with only reconstruction of the inside of the cheek and primary closure of the outside skin.…”

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

“…Numerous studies have reported on the use of pedicled LTMC flaps for reconstruction of various defects. [2][3][4][5][6][7][8][9] However, this type of flap is generally transferred to the recipient site through a subcutaneous tunnel, resulting in unavoidable waste of normal tissue and cosmetically unacceptable bulging of the tunnel region. We propose that raising an LTMC flap in a propeller fashion is a superior and reliable technique that can avoid these problems.…”