Abstract
BackgroundThe reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge.MethodsThis 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.ResultsThe 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).ConclusionsThe 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.
Highlights
Reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge
The Abbe–Estlander flap (A-EF) is suitable for reconstructing defects of clinical stage II disease; the supraclavicular fasciocutaneous island flap (SFIF) for clinical stage II or III disease; the pectoralis major muscle flap (PMMF) for clinical stage III or IV; and the trapezius island myocutaneous flap (TIMF) for clinical stage rCS III or rCS IV disease
One flap failures occurred and no significant difference was observed in the rate of flap among the A-EF, SFIF, PMMF, and TIMF groups
Summary
Reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge. We developed the folded extended supraclavicular fasciocutaneous island flap (SFIF) based on the transverse cervical vessels for reconstructing through-and-through cheek defects [9]. The folded pectoralis major muscle flap (PMMF) based on the thoracoacromial vessels [10], and folded extended vertical lower trapezius island myocutaneous flap (TIMF) based on the transverse cervical vessels can be used [11, 12]. This study compares the outcomes of A-EF, SFIF, PMMF, and TIMF pedicle flaps for reconstructing through-and-through cheek defects involving the labial commissure following cheek cancer ablation. The reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge
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