Reconstruction of Soft Tissue Defects in the Oral Cavity and Oropharynx

Abemayor, Elliot; Blackwell, Keith E.

doi:10.1001/archotol.126.7.909

Cited by 28 publications

(18 citation statements)

References 23 publications

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“…Due to the flap’s thinness, location, pliability, ease of preparation, and number of limitations as well as the lack of hair found in the patients of Asian descent, PMF has been widely used for the reconstruction of head and neck defects, including the ear, cheek, upper and lower lips, oral cavity, and oropharynx [8-12]. The platysma receives most of its blood supply through the submental artery, which is the largest branch of the facial artery, and this muscle also receives blood due to anastomosis of the ipsilateral and contralateral lingual, superior thyroid and inferior labial arteries [13].…”

Section: Discussionmentioning

confidence: 99%

Vertical platysma myocutaneous flap that sacrifices the facial artery and vein

Liu

et al. 2013

World J Surg Onc

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BackgroundPlatysma myocutaneous flap (PMF) is a generally used technique for defect reconstruction after an oral cancer resection. The aim of the study is to present our experience using vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction.MethodsA retrospective review of the medical records of 54 patients who underwent vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction was performed. A comparison between PMF that sacrificed and that preserved the facial vessels was made, and we also compared PMF that sacrificed the facial vessels with radial forearm free flap (RFFF). Statistics concerning the patients’ clinical factors were gathered.ResultsThe mean age of the 54 patients who underwent PMF that sacrificed the facial artery and vein was 62.0 ± 10.98 years. The co-morbid disease rate of PMF was 53.7%. The flap size ranged from 12 × 5.5 cm to 7 × 5 cm. Survival of the flap was found in all of the cases, with partial necrosis in four cases (7.4%) and total loss in none of the cases. The operation time was 5.7 ± 1.17 h. The complication and success rates were 27.8% and 92.6%, respectively. The 3-year and 5-year survival rates were 77.8% (21/27) and 69.23% (9/13), respectively. The majority of the patients (87.0%) in our series were satisfied with the results of the surgery. There was no significant difference between PMF that sacrificed or that preserved the facial vessels, both in success rate (P = 1) or complication rate (P = 0.72). The patients in the PMF group were older than the patients in the RFFF group (P = 0.011), the operation time was shorter (P < 0.001), and the co-morbid disease rate was higher (P = 0.002). Although the complication rate of PMF (15/54, 27.8%) was higher than that of RFFF (2/34, 5.9%) (P = 0.011), their success rates were similar (92.6%, 94.1%) (P = 1.00).ConclusionsVertical PMF that sacrifices the facial artery and vein has specific advantages including in ease preparation and limitations. This technique may provide an effective method for intraoral reconstruction. Our experience in handling the flap may contribute to the success rate.

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Section: Discussionmentioning

confidence: 99%

Vertical platysma myocutaneous flap that sacrifices the facial artery and vein

Liu

et al. 2013

World J Surg Onc

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“…In turn, improvement of microsurgical techniques in the recent few decades allowed for effective structural and functional reconstruction of the surgical defect. Traditionally, total glossectomy defects were frequently reconstructed with pedicled regional flaps (e.g., pectoralis major) as initially described by Ariyan and Baek et al More recently, however, free tissue transfer has become the mainstay of reconstruction, particularly the anterolateral thigh (ALT) and vertical rectus abdominis myocutaneous (VRAM) flaps . The goal of reconstruction aims to restore the function of the tongue to the greatest extent while providing bulk to facilitate intelligible speech and, whenever possible, safe swallowing.…”

Section: Introductionmentioning

confidence: 99%

Total Glossectomy With Free Flap Reconstruction: Twenty‐Year Experience at a Tertiary Medical Center

et al. 2019

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Objectives/Hypothesis To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy Study Design Retrospective chart review at an academic tertiary‐care medical center. Methods All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. Results Forty‐eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29–92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One‐ and 5‐year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. Conclusions Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. Level of Evidence 4 Laryngoscope, 129:1087–1092, 2019

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“…Reconstruction with a regional pedicled flap or microvascular free flap reconstruction is often preferred over healing by secondary intention, skin grafting, or reconstruction with a local flap because of concerns about insufficient tissue to close large defects, poor healing in previously irradiated tissues, and the development of scar contracture that would interfere with speech and swallowing. [3][4][5] Although regional pedicled or microvascular free flaps have become widely adopted for postablative defects of the oropharynx, most patients who undergo surgical resection for SCCOP have advanced or recurrent disease, which is associated with poor postoperative quality of life and limited survival. 6,7 Contemporary oropharyngeal reconstructive techniques must continue to be objectively evaluated to determine whether associated morbidity and functional outcomes justify more complicated reconstructions, with the attendant longer hospital stays and increased costs for surgery and postoperative care, particularly in patients with advanced disease who may have a limited chance for long-term survival.…”

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confidence: 99%