Reconstruction of complicated through-and-through cheek defects with multiple-paddled anterolateral thigh flap

Abstract

Objective To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction. Methods From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types. Results All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease. Conclusions The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed. Key words: Penetrating wound; Anterolateral thigh flap; Perforator flap; Flap transplantation