Reconstruction of extensive resection cavities after surgical treatment of the floor of the mouth cancer using two free flaps (ALT and peroneal) on microvascular anastomoses and a free chimeric flap (peroneal)

Abstract

<br/>INTRODUCTION: The authors present two case reports of patients in whom it was possible to perform a reconstruction of an extensive postoperative cavity created during the resection of the floor of the mouth and the mandible cancer. Due to their size, the cavities had to be reconstructed with the use of specially formed flaps.<br/> <br/>CASES: In the first case, in a patient with local recurrence after previous resection of the floor of the mouth cancer and bilateral neck lymph node surgery with a sagittal flap reconstruction performed in a different clinic, there were created two separate microvascular flaps - an ALT (anterolateral thigh) flap and a peroneal flap. In the second case we present a patient diagnosed with carcinoma of the floor of the mouth and the body of the tongue with infiltration of the mandible with metastases to the lymph nodes of the neck bilaterally. Due to favorable anatomical conditions, it was possible to create a chimeric sagittal flap with two skin islands, and only one microvascular anastomosis was needed for the reconstruction of the cavity.<br/> <br/>DISCUSSION: Single free flaps used in the reconstruction of cavities after resection of cancers of the floor of the mouth are limited by their size and length of the pedicle, specific to the donor areas. These limitations result in the necessity to use two free flaps for the reconstruction of cavities after extensive resections of carcinomas of the floor of the mouth, tongue, mandible and adjacent structures. Chimeric flaps reduce the risk of complications in such a situation, allowing to perform few microvascular anastomoses and reducing the number of dose fields.<br/>