Modern Oral Cavity Reconstruction with Free Flaps and Pedicled Flaps

Alberto Deganello

doi:10.4172/2472-1905.100004

Abstract

Small defects resulting from tumor ablation can be successfully managed with primary closure (i.e., limited excisions within the oral cavity), sometimes can be left to heal for secondary intention (transoral oropharyngeal/laryngeal/hypopharyngeal resections) or can be resurfaced using skin grafts or small local flaps, but in the majority of the cases the resulting defect requires a flap transposition in order to attempt a restoration of form and function and to ensure rapid and adequate wound healing. Therefore the anticipation of the resulting defect prior to surgery is crucial in order to propose the most pertinent reconstructive solution, in this light every head and neck defect should be evaluated in terms of lack of support, cover and lining, and the chosen flap should ideally approximate the resected tissues in terms of type, thickness, texture, mobility, sensation and function. Another important aspect to consider is the need to restore a separation between different compartments; in fact the surgical approach for tumor resection can often create an iatrogenic communication between the upper aerodigestive tract and neck contents, or between oral cavity and nasal/sinonasal cavities, orbital and cranial contents.

Highlights

Small defects resulting from tumor ablation can be successfully managed with primary closure, sometimes can be left to heal for secondary intention or can be resurfaced using skin grafts or small local flaps, but in the majority of the cases the resulting defect requires a flap transposition in order to attempt a restoration of form and function and to ensure rapid and adequate wound healing
This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php thick fascio-cutaneous free flaps such as the anterolateral thigh flap, [26] provide enough bulk to accomplish a restoration of form, by creating a neo-tongue/palate competence, these flaps are even able to restore some sort of initial oral propulsion of the bolus towards the pharynx
Free flaps do not suffer from pedicle-related traction and are certainly superior to pedicled flaps, in patients with vessel depleted necks (Figure 3) or when a total glossectomy is associated with total laryngectomy (Figure 4), the reconstruction with a pectoralis major myocutaneous flap or with a latissimus dorsi myocutaneous flap is an excellent alternative

Summary

Introduction

Small defects resulting from tumor ablation can be successfully managed with primary closure (i.e., limited excisions within the oral cavity), sometimes can be left to heal for secondary intention (transoral oropharyngeal/laryngeal/hypopharyngeal resections) or can be resurfaced using skin grafts or small local flaps, but in the majority of the cases the resulting defect requires a flap transposition in order to attempt a restoration of form and function and to ensure rapid and adequate wound healing. For oral and oropharyngeal soft tissue defects that require adequate lining without the need for a bulky cover, fasciocutaneous free flaps provide excellent results enabling optimal resurface, ensuring a good motility of the preserved structures around the resected area (preserved portions of the tongue, tongue base, floor of mouth, soft palate), giving a tight separation between oral/oropharyngeal cavity and neck contents.

Results

Conclusion