Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck.

Canhua Jiang,Xinchun Jian,Tong Su,Feng Guo,Ning Li,Xinqun Chen,Lian Zheng,Wen Liu,Fabio Santanelli

doi:10.1371/journal.pone.0106326

Canhua Jiang, Xinchun Jian + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0106326

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Abstract

The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.

Highlights

Though relatively uncommonly, complex soft-tissue defects of head and neck which involve multiple and nonadjacent anatomic sites can arise after radically surgery of advanced-staged malignancies or multiple lesions of the upper aerodigestive tract
We present our experience with free multipaddled anterolateral thigh (ALT) chimeric flap for functional and aesthetical reconstruction of complex head and neck soft-tissue defects involving multiple nonadjacent anatomic sites in a single operation
Between May 2009 and August 2012, a total of 12 consecutive patients with head and neck cancer indicated for radical resection and complex soft-tissue reconstruction with multipaddled ALT chimeric flaps were enrolled

Summary

Introduction

Complex soft-tissue defects of head and neck which involve multiple and nonadjacent anatomic sites can arise after radically surgery of advanced-staged malignancies or multiple lesions of the upper aerodigestive tract. Functional and aesthetic reconstruction of complex and multiple defects in head and neck is still a major surgical challenge, because the reconstruction of multiple and nonadjacent defects demand a flexible and feasible flap with multiplanar configuration and multiple paddles [1]. There are several reconstructive choices open to the clinician, including local cutaneous flaps, pedicled fasciocutaneous flaps and microsurgical free flaps. It is usually not applicable for local and pedicled flaps to reconstruct such complex defects because of their limited soft-tissue amount and less versatile design, while using two or more individual flaps for multiple defects might be an opinion, but not the best. An ideal reconstructive procedure for multiple and complex three-dimensional defects should be performed in a single stage operation, which can reduce operative time and prevent likelihood of postoperative complications

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