Full-thickness Cheek Defects Research Articles

Has the Pectoralis Major flap Really Become Obsolete?

To evaluate the current role of pectoralis major (PM) flap including the reasons for selecting it over free flaps. All patients who underwent PM flap at Apollo Hospitals Ahmedabad during the 3-year period from January 2020 to December 2022 were included. Patient demographics, tumour characteristics and complications were studied and reasons for selecting pectoralis major flap were analyzed. Data was entered in Microsoft excel spreadsheet and analyzed using online statistical calculators. The p value of < 0.05 was considered statistically significant. 57 patients underwent reconstruction with PM flap while 154 patients underwent free flap reconstruction. 54 were male and 3 were female. Median age was51 years. PM flap was used for intraoral lining in 25 patients, and it was bilobed in 26 patients with full thickness cheek defect. Most common complication was wound infection seen in 10 patients. 5 patients developed marginal necrosis of the flap and 5 had donor site wound dehiscence. No complete flap loss was seen. During the same period, 15/154 (9.74%) patients with free flaps developed complete flap necrosis and this was statistically significant (p = 0.012). Reasons for choosing PM flap were also analyzed. 14patients had major comorbidities, 18 had extensive disease, in 5 patients it was used for salvage post free flap failure, while 10 previously treated patients had unavailability of suitable vessels for anastomosis.12 patients underwent PM flap due to financial constraints. Thus, PM flap is not obsolete and continues to maintain its place in head and neck reconstruction.

Bi-Paddle Pectoralis Major Myo-Cutaneous Flap: A Step by Step Approach

We present a case of reconstruction of a large full thickness cheek defect as a result of cancer ablative surgery. This defect was reconstructed primarily by bi-paddle pectoralis major myo-cutaneous (PMMC) flap. This technique is anatomically sound, technically easy with short learning curve and also reproducible. One has to be careful, not to place more than one third of the skin paddle outside the muscle. This method of reconstruction is an alternative where microvascular free tissue transfer is contraindicated due to medical comorbidity or is not feasible due to either lack of the expertise or infrastructure. It is extremely useful in salvage in cases, in cases of the failure of microvascular flap, in selected large full thickness oral cavity lesions. However, the limitations of this method include loss of nipple area and technical difficulty in females and obese patients.

Single Stage Reconstruction of Full Thickness Defects of Cheek with Pectoralis Major Myocutaneous Flap Using an Innovative Flap Technique.

The purpose of this article is to present an innovative technique in harvesting the pectoralis major myocutaneous flap (PMMC) which is very useful for reconstruction of post-ablative full thickness defects of cheek in elderly female patients. This is a prospective study of patients who underwent reconstruction with PMMC flap for post-ablative full thickness defects of the cheek and mandible in a tertiary cancer center over a period of 36 months. Sixty patients were included in the study. Mean duration of the hospital stay was 12 days. Eight patients (13.33%) had minor wound dehiscence, 6 (10%) had marginal skin necrosis of the flap, 2 (3.33%) patients had venous congestion, and 4 (6.66%) had wound dehiscence at the palate. Four (6.66%) patients had a gradual necrosis of the outer paddle. Our modification of elevation of the PMMC flap prevents its shearing which is especially useful in raising this flap in elderly female patients affected with advanced oral cancer.

Forehead flap: a reconstructive option in selected complex defects following resection of oral cancers staged T4

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck squamous carcinoma constitutes 30% of malignancies in our region, oral carcinoma being most common among them. Most of these tumours involve lower gingivobuccal sulcus and buccal mucosa. 80% patients present with locally advanced disease. Following resection of these tumours, reconstruction of composite defects is challenging. Though microvascular free flaps are ideal in such cases, it is not always feasible due to malnutrition, peripheral vascular disease, sometimes non–availability of microvascular surgeon and financial constraints. Pectoralis major myocutaneous flap, the workhorse of reconstruction is bulky, non-pliable and cannot be advanced over intact mandible. Forehead flap in complex defects is pliable, versatile, has excellent vascularity and colour matching, easy to harvest and suitable in selected cases and as salvage flap when other flaps fail. The aim of the study was to document outcome of folded forehead flap reconstruction of complex defects following resection of T4 staged oral carcinoma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study in a tertiary rural hospital included 31 patients with oral carcinoma staged T4. The patients underwent folded forehead flap reconstruction for full thickness cheek defects with some extending into oral commissure and lower lip, along with segmental or alveolar resection of mandible or maxilla.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;27 patients had uneventful healing, 2 had wound dehiscence and 2 had necrosis of distal part of flap. Patients with externally rotated flap had mild trismus and patients in whom forehead flap was used to reconstruct the oral commissure had oral incompetence.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Folded forehead flap is good reconstructive option in complex full thickness defects of cheek and as salvage reconstruction.&lt;/p&gt;

A temporary obturator as palliative care for a patient with full-thickness cheek defect arising from squamous cell carcinoma of the buccal mucosa

We report the application of a temporary obturator as palliative care for a patient with full-thickness cheek defect arising from squamous cell carcinoma of the buccal mucosa.

Outcome in Patients with Partial and Full-Thickness Cheek Defects following Free Flap Reconstruction-A Multicentric Analysis of 47 Cases.

The objective of this study was to evaluate whether the extent of tumor resection and free flap reconstruction influences functional outcome and complications in patients with solid malignancies of the cheek. Therefore, we retrospectively assessed recipient site complications and functional outcomes in 47 patients with solid malignancies of the cheek who underwent either partial (n = 30; 63.8%) or full-thickness (n = 17; 36.2%) cheek resection with free flap reconstruction. Complications occurred in 12 (70.6%) patients after full thickness resections with creation of through-and-through defects compared to 14 (70.6%) patients with partial defects (p = 0.138). Among those 26 patients (55.3%), major recipient site complications, like development of salivary fistula or free flap loss, were observed in 10 (21.3%) and 2 (4.3%) cases, respectively, while minor complications, like wound dehiscence and local infections, were found in 14 (29.8%) and 9 (19.1%) patients. Complications were noticed particularly after reconstruction of suborbital defects (69.2%; p = 0.268), of which occurrence of salivary fistulae was the most common (46.2%; p = 0.035). Similarly, functional outcomes including oral incompetence, ectropion, and trismus were not affected by the extent of resection (p = 0.766). However, oral incompetence was higher in patients with tumors originating from the oral cavity (p = 0.020) and after the performance of mandibulectomy (p = 0.003). Overall, there was no difference in functional outcome or recipient site morbidity between tumor resections resulting in full-thickness and partial defects.

Single-Skin Paddle Anterolateral Thigh Free Flap with Ileotibial Tract for Internal Lining in Reconstruction of Full-Thickness Cheek Defect.

Single-Skin Paddle Anterolateral Thigh Free Flap with Ileotibial Tract for Internal Lining in Reconstruction of Full-Thickness Cheek Defect.

Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure

The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion. The morphology of the commissure with the mouth closed was classified based on the point of entrance of the vermilion into the oral cavity. In normal volunteers, the commissure pattern consisting of the entrance of the upper vermilion into the oral cavity before the lower vermilion and just prior to forming the oral commissure was considered to be the standard. However, in the reconstructed cases, there was an increase in the pattern in which the lower vermilion enters the oral cavity before the upper vermilion for the remaining commissure postoperatively, especially when the lower lip defects were greater than those of the upper lip. It is important to refer not only to the standard morphology of the commissure, but also to the changes according to the extent of resection and the method of reconstruction.

Tripaddled Anterolateral Thigh Flap for the Reconstruction of Extensively Full-Thickness Cheek Defects by Stacking Two Skin Paddles as Kiss Pattern.

Extended anterolateral thigh (ALT) flap can provide a large amount of skin to reconstruct the extensively full-thickness defects of cheek. However when the width of 1 skin paddle exceeds 8 cm, it always results in that the donor site cannot be closed primarily and need to be covered by split-thickness skin grafting, which delivers lots of impacts on the functional and cosmetic outcome of the thigh. The aim of this study was to introduce the authors' modification of stacking 2 skin paddles of the tripaddled ALT flap to reconstruct the extensive full-thickness defects in the cheek after the radical ablasion of advanced buccal squamous cell carcinoma. Ten patients of advanced buccal squamous cell carcinoma between March 2014 and December 2016 were enrolled in the authors' hospital. All the patients were received the soft-tissue reconstructions for the extensively full-thickness cheek defects by using the tripaddled ALT chimeric flaps. Among 3 skin paddles, the distal paddle was used to reconstruct the inner mucosa defect, and the other 2 large skin paddles were stacked side by side for outer mega cheek defect. The mean area of the intraoral defect was 32.2 cm and the mean area of the extraoral defect was 106.34 cm. The mean width of the outer skin defect was 9.5 cm. All the flaps survived and all the donor sites were closed primarily. So, stacking 2 skin paddles of a tripaddled ALT flap as a kiss pattern is a novel modification on conventional flap design to provide customized coverage for extensive and full-thickness buccal defects while minimizing donor-site morbidity.

Reconstruction of full‐thickness cheek defect with chimeric facial artery free flap: A case report

Full-thickness cheek defects represent a difficult challenge for reconstructive surgeons. Multiple techniques have been described, including local, regional, and free flaps. In this report, the reconstruction of a through and through left cheek defect, resulting from a self-inflicted gunshot injury, with a chimeric facial artery free flap is presented. The patient underwent reconstruction with a chimeric full-thickness facial artery free flap, with 9 × 3 cm diameter skin paddle and a 6 × 5 cm myomucosal paddle, was harvested on the contralateral cheek with a 7-cm length of facial pedicle. The flap was transferred via a microsurgical technique and an end-to-end microsurgical anastomosis was performed between the donor and the contralateral facial vessels. The flap was transplanted successfully and there were no donor or recipient site complications with a satisfactory esthetic result 5 years after surgery. This technique may be a good reconstructive option for medium size, full-thickness, cheek defects allowing a "like with like" reconstruction with minimal donor-site morbidity.

Reconstruction of the Three-Dimensional Mandibulofacial Defects Using a Single Cutaneous Perforator-Based Fibula Osteocutaneous Flap.

The reconstruction of the mandibulofacial defects is a difficult task when there are full-thickness cheek defects involving mandible, inner mucosa and outer skin. There are several reconstructive options for the coverage of large defects, but most of the methods are complicated, and time- and effort-consuming. We hereby present a case of fibula osteocutaneous flap based on a single peroneal artery perforator in the reconstruction of a three-dimensional mandibulofacial defects.

Reconstruction of full-thickness cheek defect with a folded cervico-pectoral cutaneous flap following ablation of advanced oral cancer in elderly patient

Reconstruction of full-thickness cheek defects involving both the oral lining and the external facial skin following ablative surgery remains a difficult task. Free flap reconstruction is the main modality of treatment, but sometimes there is a reluctance to use it in elderly patients with several comorbidities for an increased risk of non-cancer-related cause of death. This article describes a folded cervico-pectoral fasciocutaneous flap that has been used to reconstruct a full-thickness cheek defect in elderly patients. Moreover, surgical technique and aesthetic results 2 years after surgery are discussed in this article. Currently, after 2 years, the patient is free of disease and enjoys good health. In conclusion, folded cervico-pectoral fasciocutaneous flap is a fast and practical technique for reconstructing full-thickness cheek defects after tumor excision. The flap was straightforward to perform and reliable in both blood supply and cosmetic outcome, and it provides a good alternative to free flaps for cheek and upper neck reconstruction of elderly patients. Level of Evidence: Level V, therapeutic study.

Reconstruction of full-thickness buccal defects with folded radial forearm flaps

Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions.Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated.Six patients were enrolled. All flaps survived totally without any complication; the mean flap size was 75.5 (range 32–135) cm2. The mean mouth-open width was 4.2 (range 3.5–4.7) cm at 6 months after operation. All patients were satisfied with the appearance and were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling.Radial forearm flap was a reliable method for through-and-through buccal reconstruction with high success rate and good functional result.

Reconstruction of full-thickness cheek defects with a folded extended supraclavicular fasciocutaneous island flap following ablation of advanced oral cancer.

The aim of the present clinical study was to evaluate the feasibility of a folded extended supraclavicular fasciocutaneous island flap (SFIF) for full-thickness cheek defect reconstruction following ablative oral cancer surgery. The nine patients with advanced squamous cell carcinoma of the buccal mucosa were six men and three women, with a mean age of 60.8 years. All patients were treated with surgery including ipsilateral radical neck dissection. A folded extended SFIF with a skin paddle ranging between 6 × (6 + 5) cm and 7 × (10 + 9) cm were used to reconstruct the full-thickness cheek defects. One minor flap failure and one wound dehiscence in donor site occurred, but all flaps survived, and there was no major complication in any patient. All patients were able to receive all of their nutrition orally and had normal speech. The patients were followed-up for 9-28 months; six patients were living with no evidence of disease, two was living with disease, and one died of local recurrence. The folded extended SFIF to reconstruct full-thickness cheek defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of the cheek.

Crossed pectoralis major myocutaneous flap for recurrent oral cavity cancers.

Background:Oral cavity cancers are fairly common and have propensity to recur locally. Since Pectoralis Major Myocutaneous (PMMC) flap is the most widely used first flap for reconstruction, it is exhausted at the earliest and recurrence poses a formidable challenge for reconstructive surgeon. Present study evaluated the feasibility of contralateral Pectoralis Major Myocutaneous Flap for reconstruction after resection of recurrent tumour.Methods:This was a study of the patients presenting with recurrent oral cavity cancer after exhausted ipsilateral Pectoralis Major Myocutaneous Flap (PMMC) in whom we used contralateral Pectoralis Major Myocutaneous Flap (Crossed PMMC Flap) for reconstruction between October 2013 to June 2016.Results:Five patients with recurrence underwent reconstruction with contralateral Pectoralis Major Myocutaneous Flap. In all the flap was successfully used to reconstruct defects involving the entire buccal mucosa and in one patient the flap could be used to reconstruct full thickness resection defect(crossed bipedal PMMC Flap) with ease.Conclusion:Crossed Pectoralis Major Myocutaneous Flap can be used safely and reliably for reconstruction of the buccal mucosal defect and in selected patients even for full thickness cheek defect as folded bipaddle Pectoralis Major Myocutaneous Flap.

Developing an Algorithm for Reconstruction of Full Thickness Cheek Defect by Submental Flap

Developing an Algorithm for Reconstruction of Full Thickness Cheek Defect by Submental Flap

Double-Skin Paddled Superficial Temporofascial Flap for the Reconstruction of Full-Thickness Cheek Defect

The most common causes of cheek defects include trauma, burn, and tumor resections. In the reconstruction of the defects in this region, it is essential to use similar or adjacent tissue considering the aesthetic and functional properties. For this purpose, numerous local, regional, or distant free flaps were described. The local flaps harvested from the head and neck region are the most frequent methods because of the similar skin color, texture, and compatibility with cheek.In this study, the reconstruction in a 29-year-old male patient who had a full-thickness cheek defect due to tumor resection on the left side was performed, wherein a hairless skin island was carried through the frontal branch of superficial temporal artery for oral mucosa, and a hairy skin island through the parietal branch of the same pedicle was carried for the bearded skin defect. No complication occurred postoperatively and both aesthetic and functional satisfactory results were obtained, providing the oral mucosal and natural beard integrity. Donor-site scarring and temporal alopecia were recorded as the disadvantages of this method.This technique is a useful method for the reconstruction of full-thickness cheek defects because of its advantages including compatibility of color and texture, reliable blood supply, requiring single-session procedure, and being able to carry 2 different skin islands on the same pedicle.

Partial Bipaddling of PMMC Flap in Full Thickness Cheek Defects involving Lip Commissure: A Novel Technique

ABSTRACTThe reconstruction of cheek along with large lip commissural defect after excision of primary tumor is still a challenge. Though primary reconstruction with microsurgical technique is the preferred meth od, du e to infrastru ctural c on strain ts in developing countries it cannot be offered to all the patients. A number of other techniques have been described earlier, but some of them lead to microstomia, whereas other leads to oral incompetence or poor esthetic outcomes. We are proposing a novel technique of partial bipaddling of pectoralis major myocutaneous (PMMC) flap for reconstruction of such defect. This reconstruction procedure is technically less demanding with an acceptable cosmetic and functional outcome.How to cite this articleChaturvedi P, Joshi P. Partial Bipaddling of PMMC Flap in Full Thickness Cheek Defects involving Lip Commissure: A Novel Technique. Int J Head Neck Surg 2013;4(3):113-114.

Reconstruction of Full-Thickness Cheek Defects With Using Free Osseocutaneous Radial Forearm Flap

The aim of the present clinical study was to evaluate the feasibility of free osseocutaneous radial forearm flap in the reconstruction of full-thickness cheek defect after ablative cancer surgery. A retrospective review of data was obtained from consecutive patients requiring free osseocutaneous radial forearm flap to recover both the cutaneous and bone deficit in major full-thickness cheek defect after oncologic resection. Two patients had advanced cheek squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The free osseocutaneous radial forearm flap measuring 10 × 8 cm to 14 × 10 cm was used to reconstruct the major through-and-through cheek defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 1 patient was living with no evidence of disease, and 1 had died of local recurrence. The free osseocutaneous radial forearm flap to reconstruct major through-and-through cheek soft tissue and bone defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of cheek.

Bipaddled submental artery flap

Oral cancer is a major public health problem in India. Most patients present with locally advanced disease requiring complex resection and reconstruction strategies. Costs, operating time and availability of expertise are major issues that influence efficient health delivery, especially in developing countries such as India. Technically simple and widely reproducible techniques may be used successfully where applicable, to overcome these issues. The submental artery flap is a well described and acceptable alternative to the radial artery forearm free flap in oral cavity reconstruction. Researchers have demonstrated its technical ease of performance and reproducibility amongst trainees. Here the authors describe the bipaddled submental artery flap, a modification of the standard flap, which can be used to provide lining as well as skin cover for a full thickness cheek defect. Two skin paddles are fashioned taking advantage of the vascular anatomy of the submental vessels.