Application of polyflaps perforator flaps in surgical treatment of malignant conversion of oral submucous fibrosis

Abstract

Objective To investigate the clinical features of malignant conversion of oral submucous fibrosis (OSF) and the application value of polyflaps perforator flaps in its surgical treatment. Methods Ten patients who suffered from malignant conversion of OSF underwent simultaneous multiple defects reconstruction using polyflaps perforator flaps after radical tumor resection from August 2012 to October 2014. The fibrous bands leading to severe trismus near the pterygomandibular ligament as well as other intraoral lesions with malignant tendency were also resected besides from the known carcinoma. Patients with synchronous multiple primary cancers underwent radical resection and neck dissection of all other malignant lesions. The flaps were cut and tailored between adjacent perforators according to the amount and size of defects, forming several independent paddles for each defect reconstruction. Results Twenty-two defects were formed in 10 patients with malignant conversion of OSF. All of them were repaired with polyflaps anterolateral thigh (ALT) perforator flaps, including 8 cases of bipaddled ALT flaps and 2 cases of tripaddled ALT flaps. The total size of the flaps ranges from 3 cm~8 cm×6 cm~24 cm, and the pedicle length ranges from 5~12 (9.7±2.1)cm. Thirty-five perforator vessels were dissected, and each paddle included 1.6 perforators on average. All flaps survived after transplantation, and only 1 patient had infection of the neck incision. Post-operative adjuvant radio-chemotherapy was applied in 2 patients. All patients showed satisfactory accepting-site morphology with good speech function and swallowing recovery, and their trismus was improved during 6 to 30 (11.6±3.7)months. One patient died from lung metastasis 10 months after the surgery while local recurrent or metastasis did not occur in others. The donor sites were closed primarily without skin-grafting, leaving no obvious surgical donor-site complications. Conclusions Polyflaps perforator flaps can reconstruct multiple and sizable complicate defects, increase month opening by one stage operation. They are worth being applied in surgical treatment of malignant conversion of OSF. Key words: Oral submucous fibrosis/SU; Surgical flaps