Reconstruction of Through-and-through Oromandibular Defect: Comparison of Four Different Techniques

Abstract

Background:Through-and-through oromandibular defects originate from surgical intervention of tumors of the oral cavity involving external skin, soft tissue, bone, and oral lining. Reconstruction of such composite defects is primarily achieved by 4 methods using distinct flaps in Chang Gung Memorial Hospital, including a single anterolateral thigh (ALT) flap, a single fibula flap, an osteomyocutaneous peroneal artery-based combined flap, and a combination of a fibular flap and an ALT flap, also known as a double flap.Methods:In this retrospective study, 41 patients with through-and-through oromandibular defects reconstructed in Chang Gung Memorial Hospital Linkou branch from July 2007 to June 2009 using either of the 4 flaps were evaluated. Patients were divided into 4 groups according to the choice of flap, and their surgical outcomes, immediate and late complications, and their general condition were studied. Group 1 included 12 patients reconstructed with a single ALT flap, whereas group 2 included 15 patients using fibular flaps. Group 3 included 8 patients with osteomyocutaneous peroneal artery-based combined flaps, and group 4 included 6 patients who underwent reconstruction with double flaps.Results:Among all statistical results, we found that none of the differences regarding either patient demography or surgical outcomes between groups were statistically significant, except for squamous cell carcinoma staging.Conclusions:Although the results were insignificant, trends within the data could be seen that support previous notions regarding each reconstruction method. For future studies, we strongly recommend a larger sample size.

Total Surface Area of a Through-and-Through Oromandibular Defect Is Associated With Thromboembolic Events for Reconstruction With a Single Fibula Free Flap

“…Surgical complications ranged from 40% to 60%, along with a 11% to 12% total flap failure rate 11–13 . The large amount of defect after the removal of soft tissues may subsequently lead to seroma and hematoma, both of which increase the risk of soft tissue infection and plate exposure 4 . Through-and-through COMDs were thought to be associated with poor deglutition and speech and facial contour after osseous/osteocutaneous flap reconstruction 14 .…”

“…[11][12][13] The large amount of defect after the removal of soft tissues may subsequently lead to seroma and hematoma, both of which increase the risk of soft tissue infection and plate exposure. 4 Through-and-through COMDs were thought to be associated with poor deglutition and speech and facial contour after osseous/osteocutaneous flap reconstruction. 14 Approximately one-third of patients reconstructed using a single FFF in reconstructing through-and-through COMD had encountered the necessary of delay pectoralis major myocutaneous flaps due to partial flap necrosis or loss.…”

“…The more popular FFF offers the convenience of a 2-team approach, adequate bone length, and reliable skin paddle for reestablishing intraoral or buccal defect. However, it has insufficient soft tissue volume (ie, lacks an intraoral mucosa and external facial skin), leading to a difficult applicant and subsequent formation of seromas or hematomas 4,5 . A double-flap reconstruction combines an FFF with either a free fasciocutaneous flap or a regional flap (eg, anterolateral thigh, pedicled pectoralis major myocutaneous) have been well known to achieve better composite repair with better soft tissue volume for refilling defects.…”

Oromandibular reconstruction with free fibula osteocutaneous flap after oncologic resection: retrospective analysis of surgical experience and operative outcome of 56 cases

“…2,3 FFOCF become superior among the options as it provides reliable and sufficient amount of skin and soft tissue for coverage and better quality tubular bone for use of osseointegrated dental implant. 4 Now it has been gold standard after introduction of several modifications in the flap including double barrel flap, chimeric flap, double flap and combined flap. [4][5][6] FFOCF is technically complex but believed to be reliable even to start with and has a comprehensive surgical techniques and learning curve.…”

“…4 Now it has been gold standard after introduction of several modifications in the flap including double barrel flap, chimeric flap, double flap and combined flap. [4][5][6] FFOCF is technically complex but believed to be reliable even to start with and has a comprehensive surgical techniques and learning curve. We are presenting here our experience of FFOCF reconstruction of 56 cases over the last 3 years.…”