Flap In Oral Cavity Reconstruction Research Articles

Free vascularized fascial flap in oral cavity reconstruction.

Our experience with the free vascularized fascial flap based on the radial artery used for intraoral reconstruction is described. Thirteen patients underwent primary or secondary reconstruction following major resections for malignant disease. The osseofascial flap incorporating radial bone proved to be ideal when reconstruction of composite mandibular or maxillary defects was undertaken. The flaps rapidly underwent surface epithelialization, and submucosal fibrosis provided the ideal attached mucosal lining for prosthetic rehabilitation.

The folded double paddled free flap for oral cavity reconstruction

Six radial forearm flaps, two transverse rectus abdominis flaps and one latissimus dorsi myocutaneous flap were used in a bipaddled fashion for full thickness defects of the cheek and the floor of the mouth resulting from cancer resection. The flaps provided both intraoral lining and skin cover in all cases. Immediate reconstruction was carried out following tumor resection in six cases. In three patients who presented with large full thickness defects due to failure of primary reconstruction, late reconstruction with double paddled free flaps was performed. All transfers were successful, in the latissimus dorsi transfer a minimal area of necrosis occurred at the tip of the flap. A salivary fistula developed in two cases, both healed spontaneously up to three weeks postoperatively. The average operating time was 5.5 h; the average hospital stay was 13.4 days.

Skin grafts and flaps in oral cavity reconstruction.

Split-thickness skin grafts and regional flaps have been used to reconstruct deficits produced by oral cavity and oropharyngeal cancer resection in 191 patients. The rate of complication, delay in oral alimentation, and the postoperative length of hospitalization was greater for pectoralis myocutaneous and deltopectoral flap reconstructions than for skin grafts, even when comparably sized defects are considered. The adverse effect of weight loss is greater on flap reconstructions than skin grafts and is influenced little by preoperative nutritional therapy. Skin graft reconstruction is recommended for moderate and large defects. The pectoralis myocutaneous flap may be reserved for massive defects or when the anterior part of the mandible has been resected.

Reconstruction of Intraoral Defects With the Free Groin Flap

A free flap has been defined as an island flap that has been completely detached from the body and transferred to a distant recipient site, where microvascular anastomoses are done to reestablish its essential intravascular circulation. The groin flap, based on its superficial circumflex iliac artery and venae comitantes, was utilized as a free flap to close large intraoral defects in six patients following ablative cancer operations. All patients received preoperative or postoperative irradiation therapy. Four of the six free groin flap operations were clinically successful. One flap became necrotic unexpectedly after 3 1/2 weeks. Infection played a major part in necrosis of the other flap. The use of the free flap in oral cavity reconstruction offers certain advantages over regional vascular flaps but definite limitations exist.

The forehead island flap in oral cavity reconstruction.

The versatility of the temporal bone forehead flap in oral cavity reconstruction has stimulated interest in applying island flap principles to this area. A method of developing and transferring a temporally based island forehead flap into the oral cavity is described. Because the buried pedicle remains intact permanently, at least one surgical procedure is eliminated. Increased blood flow to the area via the temporal artery persists. Resection of a segment of the zygomatic arch when transferring the flap improves the postoperative cosmetic appearance and seems to improve flap survival. The flap should be delayed in poor-risk patients.