OP208: Reconstruction of complex oro-mandibular defects using single soft tissue flap-assessment of functional and cosmetic outcome

Abstract

Background Oro-mandibular defects involving posterolateral mandible and extensive soft tissue are difficult to reconstruct using single osteocutaneous flap. In this study, we evaluated the feasibility of reconstructing these defects using single soft-tissue flap and studied the functional and cosmetic outcome. Methods Patient and defect characteristics were obtained from charts. Functional and cosmetic outcome were evaluated. Results Fifty-six patients with large soft tissue and segmental posterolateral mandibular defects were reconstructed using single soft tissue flaps from May 2009 to April 2011. Defects were reconstructed with anterolateral thigh flap (ALT) in 26 patients and remaining with pectoralis major myocutaneous (PMMC) flap. None of the patients had post-operative trismus or were feeding tube dependant. The mean speech intelligibility was more than seventy percent. Two-third of patients had good or fair cosmetic outcome. Functional outcome results ALT (%) PMMC (%) P value Feeding Regular diet 2 (13.3) 4 (28.6) 0.31 Soft solids 13 (86.7) 10 (71.4) Speech intelligibility Mean (73.33) (71.43) 0.80 Trismus pre-op Yes 14 (93.3) 10 (71.4) 0.11 No 1 (6.7) 4 (28.6) Trismus post-op Yes 0 0 – No 15 (100) 14 (100) Oral competence Partial 6 (40) 2 (14) 0.12 Complete 9 (60) 12 (86) Social interaction Normal 13 (92.9) 12 (85.7) 0.54 Restricted 1 (7.1) 2 (14.3) Cosmetic outcome Poor 2 (13.3) 4 (28.6) Fair 6 (40.0) 8 (57.0) 0.26 Good 7(46.7) 2 (14.3) Conclusions Large composite oro-mandibular defects can be successfully reconstructed using single soft tissue flap with satisfactory functional and cosmetic outcome. ALT flap is preferred over PMMC in cases with multiple sub-site involvement and defect extending cranially. In appropriately selected cases, the functional outcome with PMMC is comparable.