Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes

Sittitrai, Pichit; Ruenmarkkaew, Donyarat; Klibngern, Hanpon

doi:10.1055/s-0042-1751001

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…The mean harvesting time of our supraclavicular flap was 45.45±4. 16 (20,25) We have proved that there is a positive correlation between the distal end flap necrosis and flaps longer than 22 cm. In our study, the flaps with the length of 22 cm and above increased the risk of distal necrosis while using the modified technique for harvesting the flap has resulted in better results even in flaps more than 22 cm.…”

Section: Discussionmentioning

confidence: 71%

“…Many modalities have been practical in the reconstruction of the facial defects which were challenging with the microvascular free flaps being the most popular (15). However, those modalities are not appropriate for every patient nor achieve good outcomes (16). Moreover, surgeons frequently deal with patients previously treated and presented with a recurrent disease or old patients suffering from severe medical comorbidities which may impede or impose a microvascular procedure (15).…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Zaitoun,

Fata,

ElShafei

et al. 2024

Alexandria Dental Journal

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INTRODUCTION:Rebuilding head and neck defects is a chief challenge to the maxillofacial surgeons especially after cancer resection, trauma, infection and craniofacial deformities. Earlier, the use of obturators for many years has been a successful treatment plan. However, recently several surgical modalities are available for the restoration of such defects as locoregional or microvascular free flaps. Objectives: To evaluate the reliability of the supraclavicular flap in the reconstruction of the maxillofacial defects. METHODOLOGY: Eleven patients were included in the study who required reconstruction of the maxillofacial defects due to squamous cell or mucoepidermoid carcinoma through harvesting of the supraclavicular flap (SCF). The patients were followed-up for at least 6 months. The mean harvesting time, length/width of the flap, range of mouth opening, general complications after the surgery and the complications related to the flap were assessed. Results: The mean harvesting time of the flap was 45.45±4.16 minutes. The flap mean length was 22.64±1.12 cm, whereas the mean width was 6.14±1.14 cm. The flap survived in 9 patients while two patients had complete flap loss. Conclusion: The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Zaitoun,

Fata,

ElShafei

et al. 2024

Alexandria Dental Journal

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“…In a retrospective analysis of 628 head and neck cancer patients, the major flap complication rate was 5.6% with free flaps and 2.1% with pedicled flaps ( 12 ). A study of 171 oral cavity cancer patients showed that, whereas the donor site complication rate was significantly higher with a free flap (34.2%) than with a pedicled flap (11.2%), the rate at the recipient site was no different ( 13 ). Another study of 133 flap reconstructions of full-thickness chest wall defects showed that postoperative complications were not significantly different between free ( n = 28) and pedicled flaps ( n = 105) ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Asanuma,

Tsujii,

Hagi

et al. 2024

Front. Surg.

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IntroductionMusculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer.MethodsA total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated.ResultsRib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104).DiscussionPedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8–10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

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“…In addition, the complex reconstruction with prolonged operative time and hospital stay may not be suitable in a situation such as during the recent COVID-19 pandemic. Therefore, a variety of pedicled flaps have been performed more frequently in the recent past [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction

Sittitrai,

Ruenmarkkaew,

Kumkun

et al. 2024

BMC Oral Health

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Background This retrospective study aims to compare the oncological and functional outcomes of the submental island flap versus the radial forearm free flap used for oral cavity cancer reconstruction after minimizing differences in baseline characteristics. Methods Propensity scores for each oral cavity cancer patient who underwent surgical resection and immediate reconstruction with a submental island flap or a radial forearm free flap with a flap size ≤ 60 cm2 between October 2008 and December 2021 were generated based on the likelihood of being selected given their baseline characteristics. Patients were matched using a 1:1 nearest-neighbor approach. Results The final matched-pair analysis included 51 patients in each group. The 5-year overall survival, disease-specific survival, and locoregional control rates were 70.1% and 64.8% (p = 0.612), 77.3% and 83.7% (p = 0.857), and 76.1% and 73.3% (p = 0.664), respectively, for the submental island flap group and the radial forearm free flap group. Speech and swallowing functions were comparable between groups. However, there were significantly lower rates of complication associated with both donor and recipient sites in the submental island flap group, and also the duration of hospital stays and hospital costs were significantly lower in these patients. A subgroup analysis of patients in which the reconstruction was carried out using the submental island flap procedure revealed that in selected cases, the presence of clinically and pathologically positive level I lymph nodes did not affect survival or locoregional control rates. Conclusions Although this study was not randomized, the matched-pair analysis of surgically treated oral cavity cancer patients showed that submental island flap reconstruction is as effective as radial forearm free flap reconstruction with regard to oncological and functional outcomes with lower complication rates, hospital stay, and hospital costs. This flap can be safely and effectively performed in selected cases with a clinical level I lymph node smaller than 1.5 cm and no signs of extranodal extension.

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Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes

Cited by 11 publications

References 30 publications

Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Reconstruction of Maxillofacial Cancer Defects by Supraclavicular Flaps

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction

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