Oral Cavity Defects Research Articles

Outcome of Nasolabial Flap in Buccal Mucosal Reconstruction in Oral Squamous Cell Carcinoma

Background: Surgical defects of oral cavity and orofacial region are challenging because of the aesthetic and functional demands and dynamic nature of the area. A multitude of reconstructive options are available and with the advent of musculocutaneous flaps and free microvascular tissue transfer, orofacial reconstruction has entered an era of sophistication whereby repair of defects of all types and sizes has become possible.
 Objectives: This study was conducted to evaluate the functional outcome, surface texture and complications of nasolabial flap for reconstruction in the buccal mucosal defects.
 Materials and Methods: A cross-sectional observational study was conducted 20 patients with clinical histological diagnosed squamous cell carcinoma (SCC;T1-T3 ) involving buccal mucosa attending in the Oral and Maxillofacial Surgery department of Dhaka Dental College and Hospital during this study period were included purposively in the study. All patients were treated by excision of the lesion and subsequent reconstruction of the defect by nasolabial flap. If indicated then patients received adjuvant radiotherapy. They were examined preoperatively, immediate postoperatively, on discharge and 3 months after operation. Data were analyzed by SPSS statistics (version 20) software. To find out the significance of the result one way ANOVA was conducted and the Post Hoc Test was done by LSD.
 Results: Among 20 patients 15% (3) patients developed infection, 15% (3) patients developed dehiscence. Trismus occurred in 5% (1) patient. In assessment of interincisal opening of the patients, 90% (18) presented with adequate interincisal opening but it has been reduced in 10% (2) patients after radiotherapy. In 90% (18) patients surface texture of the flap were smooth and in 10% (2) were partially smooth.
 Conclusion:The nasolabial flap has proved to be a useful and reliable option for reconstruction of defects of the buccal mucosa in order to allow wound closure without tension and maintain oral function.
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 48-53

The management of submental flap in the reconstruction of the oral cavity and skin of face defects

One of the most current problems in surgical treatment of the head and neck malignant neoplasms is the necessity for plastic replacement of defects that occur after tumor removal. The management of a submental flap in 34 patients with squamous cell cancer of the oral cavity and skin cancer of the face has been analyzed. There were 29 males and 5 females. The average age of patients was 56.9±5.23 years. The squamous cell cancer of the tongue was diagnosed in 18 patients, the floor of mouth — 7, the mucous of the cheek — 5, the retromolar triangle — 1 and skin basaloma of face in 3 patients. Single-stage reconstruction of postoperative defects after removal of the primary tumor was carried out simultaneously with the neck dissection. The submental flap with orthograde blood supply was used for reconstruction of the oral cavity defects in 31 patients and submental flap with the retrograde variant of blood supply was used to replace skin defects of face in 3 patients. The flap, which included skin, subcutaneous fat and the anterior belly of digastric muscle was used in 25 patients. A submental flap that included skin, subcutaneous fat, anterior belly of digastric muscle, and the fragment of the mylohyoid muscle was used in 9 patients. Total flap failure was observed in 2 patients and partial flap failure was observed in 3 patients. To replace the defect the supraclavicular artery skin and fascial flap were used in patients with total flap failure. Completion of primary plastics was 94%. Salivary fistula was observed in 2 patients and orostoma was not observed. Oral nutrition was restored for all 33 patients with oral cancer after surgery on 7–8 day. The hematoma in the donor’s site was diagnosed in 1 patient and partial sutures failure was observed in 4 patients. The obtained results allow us to recommend the submental flap as an effective way to reconstruct the defects of the oral cavity and the skin of the face after the removal of malignant tumors.

THE USE OF SUBMENTAL LOCAL FLAP AND RADIAL FREE FLAP FOR THE RECONSTRUCTION OF DEFECTS IN PATIENTS WITH ORAL CANCER

Introduction.Due to anatomical features, surgical treatment of oral cancer can lead to significant functional and esthetic defects. Main methods of reconstruction can be divided into groups of local and free flaps. There are lots of publications devoted to reconstruction of defects of oral cavity with the use of local and free flaps, but only few of them contain the comparison of these methods in the aspect of functional results.Materials and methods.A total of 58 patients with oral cancer were included in our study. All patients received surgical treatment with one-time reconstruction of defect. In 34 cases we used free radial flap and in 24 – submental local flap.Results.The use of submental flap has advantages in the intraoperative time, time of recovery, functional results, with the same locoregional control.Conclusions.We suggest submental local flap and radial free flap to be the method of choice in reconstruction of mucosa and soft tissues defects in patients with primary and recurrent oral cancer.

Functional considerations in oral cavity reconstruction.

The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life. Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types. Free flap reconstruction has greatly enhanced the ability to tailor transferred tissue to specific defects. In this review, we describe recent findings in reconstruction of tongue defects, including data from perforator flaps. We also summarize recent evidence regarding reinnervated flaps. When vascularized tissue is needed, it remains unclear how the reconstructive choice impacts postoperative outcome, although in many situations it appears to be dominated by the donor site morbidity rather than the reconstructive technique. Despite numerous case series, the functional impact of motor and sensory reinnervation in vascularized tissue remains unknown. Although perforator flaps have emerged as a promising flap option, with favorable donor site morbidity, their ultimate impact on functional outcomes remains unclear, whereas the success rate appears to be lower than traditional flaps.

Evaluation Of Epithelization When Amniotic Membrane Use As A Biologic Dressing In Oral Cavity

Background:Skin act as a protective barrier to prevent the contamination from environment and dehy- dration of tissue. After any surgery to the oral cavity, wound closure or reconstruction is mandatory which is done by skin graft and skin substitute like amniotic membrane by the process of epithelializa- tion and tissue regeneration. Amniotic membrane is use as skin substitute in burn, eye and oral cavity as biologic wound dressing.Objective:To evaluate the epithelialization after use of amniotic membrane in mucosal defect of oral cavity as a biologic dressing.Methods:This was a prospective study which included 26 with premalignant lesion in buccal mucosa who under went excision of the lesion from intraoral buccal mucosa between January 14-june 15 and post operative follow up for 4-6 month after the surgical procedure. We used amniotic membrane(am) for dressing of the defects in buccal mucosa of oral cavity under local anesthesia. Efficacy of this procedure was assessed by granulation tissue formation with surface epithelialization on the graft site.Results:The epithelialization evaluated in postoperative period. According to sex 40 males 70% and 30 females age 22-72 years with means age 45.0±10.5 years. After excision of lesion from buccal mucosa amniotic membrane was grafted on the defect. Completeadherence of amniotic membrane in most of the cases.Wound covered by epithelialization was entire wound coverage in 85% and Nearly entire wound coverage in 15% when use amniotic membrane use as a biologic dressing in oral cavity. No allergic reaction occurs in any patients.Conclusion: Amniotic membrane can be useas a skin substitute in buccal mucosa of the oral cavity.Update Dent. Coll. j: 2018; 8 (1): 36-40

The Radial Forearm Flap: A Technique Modification for Oral Cavity Composite Defects Involving a Marginal Mandibulectomy

The radial forearm flap is a versatile reconstructive option for oral cavity defects with highly reliable success rates. We encountered more than one flap compromise when we used a radial forearm flap to reconstruct the soft tissue and provide coverage over the mandible, after a marginal mandibulectomy. From this observation, we modified our technique for radial forearm harvest and inset to avoid placing the pedicle in compression against the mandible. The purpose of this article is to present the cases that led to this observation, and present the technique modification in design and execution that we have used.

Infrahyoid Flap, a Convenient Alternative for Reconstruction of Tongue and Floor of Mouth Defects: Case Series.

The aim of this study was to share our clinical experience with the neurovascular myofasiocutan infrahyoid flap (NMIHF), which was used for the reconstruction of the defects after oral cavity cancer surgery. Records of five patients who were diagnosed with oral cavity cancer and underwent tumor resection, neck dissection, and defect reconstruction with NMIHF between 2012 and 2017 were analyzed retrospectively. The infrahyoid flap was used in five patients: four males and one female. The mean age of patients was 61.8 years. Four patients underwent tumor resection and bilateral level I-III neck dissection, whereas one patient underwent tumor resection and unilateral level I-III neck dissection. NMIHF was used for the reconstruction of the defects during the same procedure in all the patients. Mean post-operative follow-up was 30.6 months. Partial skin necrosis was observed in two patients, but none of the patients showed total necrosis of the flap. Postoperatively, oral intake was initiated after an average of 12 days in all patients. For two patients who required post-operative radiotherapy (RT), the treatment was started after an average of 50 days. NMIHF does not prolong operation time and does not cause additional scar in the neck, and the defect in the donor field can be closed without the use of a graft or flap. This is considered to be a reliable and successful alternative to free flaps for the reconstruction of oral cavity defects.

Correlation Between Articulation Disorders and Oral Motor Mechanism

Function of oral cavity is to produce speech sounds for verbal communication along with performance of its primary functions. Its defects can decrease intelligibility of speech while affecting production of phonemes. Description of this relationship is important for etiologic diagnosis and treatment planning among children without any disability or ignored craniofacial deformities. Studies highlighting this relationship are rare to none in Pakistan. Therefore, this study aims to detect the type and extent of relationship between these two factors. Methods: A descriptive cross sectional study was conducted on a sample of 140, which were 4-8 years old children with speech sound disorders, without any disability, and visiting various speech clinics in Pakistan. Test for Assessment of Articulation and Phonology in Urdu (TAAPU) was applied as it contains both oral motor screen and articulation tests. Results: The study examined the relationship between Oral Motor Mechanism (OMM) and Articulation Disorders. Oral motor screening of 140 children showed that (23%) had OMM defects among these 33% had substitution errors, 60% distortion errors, and 3.03% omission errors whereas no addition errors were found. The correlation of 0.763 positive relationships between two variables was noticed. High percentage of distortion errors among children having OMM defects shows strong connection between the two otherwise substitution is most prevalent error. Conclusion: Conclusively it can be stated that anatomical and physiological defects of oral cavity lead to articulation errors. Children with articulation deficit had distorted speech with multiple oral motor anomalies.

Nasotracheal Intubation: The Preferred Airway in Oral Cavity Microvascular Reconstructive Surgery?

We aimed to describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT). We implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed enhanced recovery-after-surgery protocol. The primary outcome measurement was hospital length of stay (LOS). The secondary outcome variables were the duration of mechanical ventilation, intensive care unit (ICU) LOS, need for gastrostomy, and airway-related complications directly associated with either NTI or tracheostomy. Descriptive statistics and a multivariate logistic regression analysis were completed. The sample was composed of 141 patients who had undergone oral cavity FTT for both benign and malignant diseases (NTI, n=111; tracheostomy, n=30). Patients managed with NTI had a statistically significantly shorter hospital LOS (8days vs 15.5days, P<.0001) and ICU LOS (1day vs 2days, P=.0006), as well as a decreased requirement for gastrostomy (17.1% vs 76.7%, P<.0001). Airway-related complications were rare in both the tracheostomy (13.3%) and NTI (3.6%) groups. Multivariate analysis showed that patients undergoing tracheostomy were 3.14 (P=.004) times more likely to have a prolonged hospitalization and 10.4 (P<.0001) times more likely to require a gastrostomy. A sensitivity analysis of only patients with malignant diagnoses had similar statistically significant results. The delayed tracheostomy rate in the NTI group was 3.6%. To date, this is the largest study to evaluate the use of NTI in patients undergoing oral cavity reconstruction with FTT. Our results suggest that in the appropriate institutional setting, most patients can be safely managed with NTI. This approach results in a decreased hospital LOS and ICU LOS and an earlier resumption of oral intake with less need for gastrostomy.

Abstract QS58: Indications and Outcomes of Single-Pedicle versus Two-Pedicle and Multiple Simultaneous Thigh Free Flaps in Head and Neck Reconstruction

PURPOSE: The anterolateral thigh (ALT) free flap is one of the most commonly used flaps for head and neck reconstruction. Given that perforators of an ALT flap routinely arise sequentially from the descending branch of the lateral circumflex artery as it descends down the thigh, a long ALT flap can be more reliably harvested than a wide ALT flap. The purpose of this study is to demonstrate indications and outcomes for single-pedicle ALT free flaps compared to double-pedicle ALT flaps as well as multiple simultaneous thigh (MST) flaps. METHODS: Our series of 81 consecutive patients undergoing head and neck reconstruction with an ALT flap was retrospectively reviewed. Patients with a composite mandibular defect who underwent reconstruction with both a fibular free flap and an ALT free flap were excluded. Receiver operating characteristics curve analysis was performed to determine our cut-off values for width and length of single-pedicle versus double-pedicle ALT flaps. RESULTS: Fifty-seven and 18 patients were reconstructed with an ALT flap with one or two pedicles, respectively. Six patients underwent MST flaps. Defect size (width ≥12 cm, length ≥17 cm) for cutaneous defects (p<0.05), the presence of divergent mucosal defects, and through-and-through oral cavity or pharyngeal defects were associated with the use of two pedicles. There was one flap failure of a single-pedicle ALT flap. While operative time was increased for the groups of double-pedicle ALT flaps and MST flaps, there were no flap complications including partial flap loss, venous congestion, or wound healing issues from poor flap perfusion. CONCLUSION: Harvesting an ALT flap with two pedicles has the potential to reduce flap complications and should be considered for divergent and extremely wide (>12 cm) or extremely long (>17 cm) defects. Our proposed algorithms will help guide flap choice when designing an ALT free flap for a cutaneous and/or mucosal defect of the head and neck. B.B. Trinh: None. I.E. Rodriguez: None. F.W. Deleyiannis: None.

Multi-dimensional analysis of oral cavity and oropharyngeal defects following cancer extirpation surgery, a cadaveric study

BackgroundDefects following resection of tumors in the head and neck region are complex; more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes. The objectives of our study were: 1) to improve the understanding of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resection and 2) to assess the geometric dimensions and the shapes of fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects.MethodsThis study was an anatomic cadaveric study which involved creating defects in the oral cavity and oropharynx in two cadaveric specimens. Specifically, partial and total glossectomies, floor of mouth excisions, and base of tongue excisions were carried out. These subsites were subsequently geometrically analyzed and their volumes measured. The two-dimensional (2D) assessment of these three-dimensional (3D) structures included measures of surface area and assessment of tissue contours and shapes.ResultsThe resected specimens all demonstrated unique dimensional geometry for the various anatomic sites. Using 2D analysis, hemiglossectomy defects revealed right triangle geometry, whereas total glossectomy geometry was a square. Finally, the base of tongue defects exhibited a trapezoid shape.ConclusionsCustomizing the geometry and dimensions of fasciocutaneous free flaps so that they are specific to the confronted head and neck defects will likely result in better functional and cosmetic outcomes.

Versatility of Modified Nasolabial Flap in Oral and Maxillofacial Surgery.

BackgroundTo evaluate the versatility and reach of modified nasolabial flap used in reconstruction of defects created in and around the oral cavity.MethodsA total number of 20 cases were selected. Out of which 13 were males and 7 females. The age of these patients ranged from 24–63 years. 29 modified nasolabial flaps were raised in twenty patients. Based on clinical and histopathological examination, out of 20 patients, 14 patients were diagnosed with oral submucous fibrosis, 3 with verrucous carcinoma, 1 with squamous papilloma, 1 with oro-antral fistula and 1 with traumatic loss of lower lip.ResultsMinimum preoperative interincisal distance (IID) was 0 mm and maximum was 15 mm with mean of 6.00±4.76 mm in patients with oral submucous fibrosis and 12 months postoperatively minimum IID was 16 mm and maximum was 41 mm with mean of 28.00±8.96 mm. In one case, dehiscence (3.4%) was noted on the anterior tip for which tip revision was done. Bulky appearance of the flap intraorally was observed in 2 cases (6.9%). Five (17.2%) among the 29 flaps had visible scar at the donor site postoperatively up to 3 months.ConclusionNumerous reconstructive techniques have been employed in the reconstruction of small to intermediate sized defects of oral cavity. Modified nasolabial flap is a versatile flap which has robust vascularity and can be successfully used with minimal complications. It can be rotated intraorally to extend from the soft palate to the lip. Thus, it can be used efficiently to treat the small defects of the oral cavity as well as recreating lost lip structure.

Supraclavicular flap repair in the free flap era.

Supraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors' objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature. The authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years' literature; 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs. SCF is suitable for a wide variety of oral cavity, pharyngeal, skull base and cutaneous defects. Consistent with our experience, SCF is highly reliable even in previously irradiated or dissected necks, so long as the supraclavicular artery is intact. Our case series shows minor complications in 3/30 (10%) and flap loss in 1/30 (3.3%) cases. The literature reports a similar rate of complete flap failure of 3.4% and a slightly higher average minor complication rate of 24.6%. We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.

Reconstruction of oral cavity defect using versatile buccinator myomucosal flaps in the treatment of cT2–3, N0 oral cavity squamous cell carcinoma: Feasibility, morbidity, and functional/oncological outcomes

ObjectivesTo evaluate the results of oral cavity reconstruction using various types of buccinator myomucosal flap (BMMF) for the treatment of cT2–3 oral cavity squamous cell carcinoma (OCSCC). Materials and methodsTwenty-two consecutive patients who underwent surgical management for OCSCC and reconstruction using various types of BMMF were enrolled. Surgical results, complications, speech/swallowing outcomes, and recurrence were evaluated. ResultsThe mean flap harvest time was 28.6 min. Complete flap necrosis occurred in one (4.5%) patient in whom an island flap was used. There were no other major complications. All patients demonstrated normal speech and swallowing functions, with articulation correctness >90% and a mean swallowing satisfaction score of 9.6. Occult neck lymph node metastasis was found in three (13.6%) patients; however, no recurrence at level I was observed. ConclusionsReconstruction of the oral cavity using various types of BMMF is feasible for treatment of cT2–3 OCSCC, and yields favorable outcomes with minimal morbidity.

Cervicofacial-facial artery myocutaneous flap (C-FAM flap): A novel flap in oral cavity reconstruction.

Reconstruction is an integral part of the surgical management of oral cancer. Local flaps are one of the options in reconstruction of small to moderate sized defects of oral cavity. Reconstruction is an integral part of the surgical management of oral cancer. Every defect needs to be assessed individually to tailor made the reconstruction because of its multidimensionality and complexity. Varieties of autologous tissues are being used in reconstruction like local, regional, or free flaps which can be simple or complex tissues. There is always a trend to identify the newer flaps/technique to personalize reconstruction. Local flaps are also one of the options in reconstruction of small to moderate sized defects of oral cavity. Local tissue if it is available is in the primary surgeon's purview and the flap can be raised without much technical difficulty and morbidity. We used perforator based tissue from the face and neck which is richly supplied by the facial vessels and named as the Cervicofacial- Facial Artery Myocutaneous flap (C-FAM flap) for reconstruction of oral cavity. We used perforator based local tissue from the face and neck which is supplied by facial vessels and named it as the C-FAM flap for the reconstruction of oral cavity defects. Twenty-eight patients underwent C-FAM flap reconstruction in different subsites of the oral cavity with acceptable functional rehabilitation. There was no flap loss. The C-FAM flap is a robust flap, which is reliable, pliable, and rich in its vascularity. It has to be one of the armamentarium for the oral cavity reconstruction. C-FAM flap: A Novel flap in Oral cavity reconstruction.

A vascularized preputial free flap for labial reconstruction in a dog.

To describe the clinical application of a vascularized preputial free flap in the reconstruction of a large facial-labial defect. Case report. An adult neutered male mongrel dog with a large left facial-labial defect. A preputial free flap was created by elevating the cranial part of the prepuce, using the ipsilateral caudal superficial epigastric vessels as a vascular pedicle. The flap was transferred to the facial-labial defect and the donor vessels anastomosed to the sublingual artery and vein, using standard microvascular technique. The free flap survived, leading to good cosmetic and functional outcomes. No major complications were encountered at either the donor or recipient sites after 2 years of follow-up. Vascularized preputial free flaps can be used to manage composite facial and oral cavity defects involving large areas of skin and mucosa.

A Retrospective Volume Matched Analysis of the Submental Artery Island Pedicled Flap as Compared to the Forearm Free Flap: Is It a Good Alternative Choice for the Reconstruction of Defects of the Oral Cavity and Oropharynx?

The submental artery island pedicled flap (SMIF) is an underused alternative for reconstruction of head and neck defects after tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients who underwent reconstruction with the SMIF versus the forearm free flap (FFF). A retrospective cohort study of all patients with oral cavity and oropharyngeal defects reconstructed with the SMIF and a cohort of patients with similar volume defects reconstructed with the FFF were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by analysis of variance and Fisher exact test. Average age was 61.8years in the SMIF group versus 57.9years in the FFF group. The most common defect was located in the tongue, with squamous cell carcinoma being the most common pathology identified. Flap volumes were similar (SMIF, 38.79cm3; FFF, 39.77cm3). Significant comparative outcomes identified with SMIF versus FFF reconstruction included shorter anesthesia times (815 vs 1,209minutes; P<.001), shorter operative times (653 vs 1,031minutes; P<.001), and less blood loss (223 vs 398mL; P=.04). Postoperative Eastern Co-operative Oncology Group performance score increased more for the FFF than for the SMIF group (+0.33 vs+1.25; P=.0019). Recipient site complication rates were lower for the FFF group (0.17 vs 0.42 per patient) but were not statistically relevant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5months. This is the first study to compare the SMIF with the FFF for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option compared with the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity.

Ulnar fasciocutaneous free flap for reconstruction of oral cavity defects: a retrospective review

Ulnar fasciocutaneous free flap for reconstruction of oral cavity defects: a retrospective review

Calf Perforator Flaps: A Freestyle Solution for Oral Cavity Reconstruction.

Reconstruction of oral cavity defects requires a thin, pliable flap for optimal functional results. Traditional flap choices are imperfect: the anterolateral thigh flap is excessively thick, whereas the radial forearm flap has a poor donor site. The authors therefore favor calf perforator flaps such as the medial sural artery perforator flap to provide thin tissue with an acceptable donor site. This two-part study aims to demonstrate their suitability for intraoral reconstruction. In the radiologic part of the study, the authors compared thigh and calf tissue thickness by examining lower limb computed tomographic scans of 100 legs. For their clinical study, they collected data prospectively on 20 cases of oral cavity reconstruction using calf perforator flaps. The mean thickness of the calf tissue envelope was significantly less than that of the thigh (8.4 mm compared with 17 mm) based on computed tomographic analysis. In the clinical study, a medial sural artery perforator was used in the majority of cases (17 of 20). The mean pedicle length was 10.2 cm and the mean time to raise a flap was 85 minutes. There were no flap losses. One patient was returned to the operating room for management of late hematoma and wound dehiscence. Calf perforator flaps provide ideal tissue for intraoral reconstruction and are significantly thinner than anterolateral thigh flaps. In addition to medial sural artery perforator flaps, the authors raised both sural and soleal artery perforator flaps in this series. Opportunistic use of the calf donor site allows the harvest of thin tissue with minimal donor-site morbidity. Therapeutic, IV.

Quantitative analysis of chronological changes in the volume of flaps used for reconstruction of oral cavity defects.

Reconstruction of oral defects using flaps following resection of oral cancer has become a standard approach for restoration of oral function. The purpose of this study was to investigate chronological changes in the volume of such flaps used for reconstruction and the factors affecting flap volume. We performed a retrospective analysis of 17 patients who had undergone oral cancer resection and reconstruction with flaps. Measurements were performed using data from computed tomography, and the flaps were selected semi-automatically using a computer-operated region-of-interest system. The data indicated that the change in total flap volume at 1 year after surgery was 30.6%, and that body weight loss was a risk factor for volume reduction. Our results suggested that flaps should be at least 30% larger than the defects they are intended to repair. However, as large flaps have the potential to cause upper airway obstruction, flap volume should be determined on an individual basis according to defect size and location.