Maxillofacial Soft Tissue Defects Research Articles

Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap

To investigate the characteristics of the clinical application of ulnar artery flap in the repair of oral and maxillofacial soft tissue defects. The clinical data of 12 patients with oral and maxillofacial defects repaired with ulnar artery flap between June 2021 and July 2023 was retrospectively analyzed. Among them, 11 cases were male and 1 case was female; their ages ranged from 28 to 76 years, with a mean age of 54.8 years. The lesions were located in the lateral margin of the tongue in 3 cases, the root of the tongue in 2 cases, the base of the tongue in 4 cases, and the buccal region, upper gingiva, and lower lip in 1 case each. The pathological types were squamous cell carcinoma in 11 cases and adenoid cystic carcinoma in 1 case; according to the TNM staging of the International Union Against Cancer (UICC), there were 5 cases of T 3N 0M 0, 2 cases of T 3N 1M 0, 1 case of T 4aN 0M 0, 1 case of T 4aN 1M 0, 1 case of T 4aN 2bM 0, and 2 cases of T 4aN 2cM 0. After complete resection of the lesion, the defect ranged from 6 cm×3 cm to 8 cm×5 cm. Preoperatively, colour Doppler ultrasound was used to detect the non-dominant forearm, measure the thickness of the subcutaneous fat in the donor area, confirm and mark the ulnar artery and reflux vein, and measure the diameter of the vessels, flow velocity, and the perforator position; intraoperatively, the flap was designed, prepared, anastomosed, and positioned according to the corresponding data. The vessels were all anastommosed with one artery and two veins to form a super-reflux. After complete hemostasis, the defects were repaired with sliding flap (2 cases), direct suture (4 cases), biomembrane (2 cases), or razor thin skin graft (4 cases). No vascular crisis occurred after operation, and all the flaps survived in 12 cases. Wounds in the donor site healed by first intention in 10 cases and by second intention in 2 cases. Wounds in the recipient site healed by first intention in all cases. All 12 patients were followed up 5-18 months, with an average of 11.4 months. The colour and texture of the flap were normal. The function of hand and upper limb was evaluated according to the trial standard of upper limb function assessment of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the score was 65-81 (mean, 71.3), and achieved excellent in 1 case and good in 11 cases. The score of Oral Health Impact Scale (OHIP) was 9-18, with an average of 14.2, and the oral function was satisfactory. During the follow-up, 1 case had local recurrence and underwent extended resection again, while the other patients had no recurrence or metastasis. For moderate soft tissue defects with complex oral and maxillofacial function, ulnar artery flap repair is effective.

Precise maxillofacial soft tissue reconstruction: A combination of cone beam computed tomography and 3dMD photogrammetry system

IntroductionThe reconstruction of both extra- and intra-oral soft tissue defects, particularly in restoring the morphology of the lip and the corners of the mouth, has posed a significant challenge for surgeons. Inappropriate methods often lead to maxillofacial deformity which then causes psychological and functional problems. This study aimed to address the challenge of reconstructing extensive and complex maxillofacial soft tissue defects, mainly focusing on the lip, the corners of the mouth, and the surrounding areas. Materials and methodsWe developed a reconstruction approach by combining the 3dMDface System (3dMD) with the cone beam computed tomography (CBCT). Firstly, with the extra-oral incision line, we evaluated the shape and the size of the extra-oral defect with 3dMD digitally. Then we used the corresponding maxillary and mandible tooth positions to record the intra-oral defect, which was then converted to digital images by combining 3dMD and CBCT. The islands of the anterolateral thigh perforator flap were then designed after the locations of the perforators were detected with Doppler ultrasonography. ResultsA clinical case diagnosed as dermatofibrosarcoma protuberans was presented to illustrate the approach. The patient's tumor resection and the size of multiple defects were measured and simulated via the virtual surgery system. A three-island perforator flap from the descending branch of the lateral femoral circumflex artery was designed accurately. Two weeks postoperatively, the flap was healed as anticipated and the patient was satisfied with the profile. ConclusionThe combination of the 3dMD and CBCT technologies improves the accuracy and fitness of extra- and intra-oral soft tissue reconstruction.

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. Eight patients (mean age 55.8y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9cm 2 (range 17-85cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90d). Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

Comparison Between Modified Lateral Arm Free Flap and Traditional Lateral Arm Free Flap for the Reconstruction of Oral and Maxillofacial Soft Tissue Defects.

ObjectiveThe traditional lateral arm free flap (tLAFF) has the disadvantages of short vascular pedicle, small vascular diameter, and non-perforator flap. We used a new method to prepare modified LAFF (mLAFF) and evaluate its application value in the repair of oral and maxillofacial soft tissue defects.MethodsThe anatomical features of the flap were recorded and compared between the tLAFF group and the mLAFF group. All the flaps in the modified group were perforator flaps. Statistical analysis was performed on the data using ANOVA on SPSS 22.0 statistical software package.ResultsForty-five mLAFFs were prepared as eccentric design rotation repair perforated flap, or multi-lobed or chimeric perforator flaps. Compared with the tLAFF, the vascular pedicle length of the mLAFF was increased, and the outer diameter of the anastomosis was thickened. The damage to the donor site was less. The difference was statistically significant.ConclusionThe mLAFF can effectively lengthen the vascular pedicle length and increase the anastomosis diameter. Perforator LAFFs in the repair of oral and maxillofacial defects have good application value.

Application of Personalized Free Anterolateral Femoral Flap in the Repair of Oral and Maxillofacial Soft Tissue Defects

Application of Personalized Free Anterolateral Femoral Flap in the Repair of Oral and Maxillofacial Soft Tissue Defects

Computed tomography angiography–aided individualized anterolateral thigh flap design in the reconstruction of oral and maxillofacial soft tissue defects

To evaluate a novel method and computed tomography angiography (CTA) for locating anterolateral thigh flap (ALTF) perforators to design individualized ALTFs to reconstruct maxillofacial soft tissue defects. This study comprised a group of 36 patients (CTA group) with malignant oral and maxillofacial tumors who underwent CTA and who received individualized ALTFs and a group of 28 patients (control group) with the same condition but without preoperative CTA examination and with nonindividualized ALTFs. ALTFs in the CTA group were designed and harvested using the locating device and CTA, whereas ALTFs in the control group were designed and harvested according to each surgeon's experience. Fifty perforators were located and 36 ALTFs harvested in the CTA group. In the control group, 34 perforators were located and 28 ALTFs harvested. Less time was required to locate the perforators in the CTA group. Moreover, the CTA group had a higher flap survival rate and better patient satisfaction regarding the postoperative aesthetics and phonetic and swallowing functions. The results suggest that CTA and the locating device can be used to accurately locate ALTF perforators and that this method aids in the design and harvesting of individualized ALTFs to achieve good functional and aesthetic outcomes.

Correlation Between Body Mass Index and Anterolateral Thigh Flap Thickness: A Retrospective Study From a Single Center in China.

Background: During repair of oral and maxillofacial soft tissue defects, organ function is largely related to the amount of thickness of the flap. However, there are few studies on the influencing factors of the thickness of the flap. In this retrospective study, we aim to explore the correlation between body mass index (BMI) and anterolateral thigh (ALT) flap thickness by computed tomography (CT) and ultrasound and provide guidance for evaluating the ALT flap thickness before surgery.Methods: We selected three points A, B, and C on ALT flap and two skilled clinicians measured the thickness of these points. Age and gender as covariates and evaluated by the Chi-square analysis. Inter-group differences between the two BMI groups were examined by the student t test. Intra-group differences within each BMI group were tested by ANOVA. Linear regression analysis was performed to examine the relationship between BMI and ALT flap thickness.Results: One hundred sixty patients measured by CT were included in this study, and the ALT flap thickness measured by CT were 8.96 mm and 11.00 mm (P < 0.0001, t test) at point B in groups with BMI<24.0 and BMI≥24.0, respectively. The thicknesses at points A, B, and C were significantly correlated with the BMI (P < 0.001, correlation analysis, r = 0.462, 0.372, and 0.349 at the points A, B, and C, retrospectively, Pearson test).Conclusion: There was a significant correlation between the ALT flap thickness and BMI. A higher BMI was correlated with a thicker ALT flap.

Evaluation of the effect of free fibular flap transplantation in repairing mandibular osteoradionecrosis defect in 151 cases

Objective: To investigate the clinical effect of free fibula flap transplantation in repairing the defect of mandibular osteoradionecrosis (ORN). Methods: A total of 151 mandibular ORN patients undergoing free fibular flap transplantation were selected from August 2005 to September 2020 in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Among them, 109 patients were males and 42 patients were females, aged (54.1±10.1) (ranged 31-85) years old. The clinical data of the patients was collected and the survival rate of the flaps and postoperative function were calculated to evaluate the surgical efficacy. The χ2 test was used for difference analysis. Results: Among the 151 patients, mandibular ORN caused by radiotherapy for nasopharyngeal carcinoma accounted for 79.5% (120/151). The average time for mandibular ORN appeared was 5(6) years after radiotherapy. Facial artery [57.2%(87/152)] and superior thyroid artery [32.9%(50/152)] were the main anastomotic arteries in the recipient area. There was no significant difference in the necrosis rates of the two flaps [10.3%(9/87) and 12.5% (5/50), respectively, P=0.949]. The main anastomotic veins in the recipient area were the external jugular vein [48.4%(135/279)] and the common facial vein [26.5%(74/279)]. Twenty-five cases (16.6%) had one vein anastomosed, and 126 cases (83.44%) had two veins anastomosed. There was no significant difference in the flap necrosis rate between the two conditions [20.0%(5/25) and 7.1%(9/126), respectively, P=0.100]. Ninety-seven cases (64.2%) used the peroneal musculocutaneous-fascia composite flap to repair the maxillofacial soft and hard tissue defects. Thirteen cases (8.6%) underwent the restorations with digital virtual surgery design, of which 5 cases were repaired with dental implants at the same time. After the operations, lower respiratory tract infection occurred in 17 patients (11.3%), and upper respiratory tract obstruction occurred in 3 cases (2.0%). The survival rate of the flap after operation was 90.7% (136/151), and 21 patients (13.9%) had flap vascular crisis. Delayed healing of maxillofacial wounds occurred in 33 cases (21.9%). After 3 to 24 months of follow-ups, 110 patients (76.9%) had no fistula inside/outside the oral cavity, 118 patients (82.5%) had an improvement in opening mouth of increasing (≥0.5 cm) after surgery, 135 patients (94.4%) had pain relief, 97 cases (67.8%) could eat normal diet, semi-liquid or soft food, and 137 cases (95.8%) were satisfied or basically satisfied with the treatment effects. Conclusions: The free fibular flap transplantation is an effective method to repair mandibular ORN defects. Preoperative vascular assessment is helpful for the selection of recipient vessels. Facial artery, superior thyroid artery, external jugular vein and common facial vein can be used as the main recipient vessels. The repair of the peroneal musculocutaneous-fascia composite flap facilitates the closure of internal and external fistulas. Digital technology can help to restore the maxillofacial shape more accurately, improve the patient's occlusal and chewing function and enhance the quality of life of mandibular ORN patients.

Application of high frequency color Doppler ultrasonography combined with microvascular stapler in maxillofacial defect repair

Objective:To evaluate the clinical application value of high frequency color Doppler ultrasound（HFCUS） combined with microvascular stapler in the repair of oral and maxillofacial defects with the anterolateral thigh perforator flap. Method:Forty maxillofacial malignant tumor patients were divided into HFCUS+stapler group（23 cases） and control group（17 cases）. All of cases used anterolateral thigh flap without fascia lata to repair the soft tissue defect in the operative area. One artery and two veins were anastomosed during the operation. The flaps were harvested from 6.0 cm×7.0 cm to 10.0 cm×12.0 cm, and the donor sites were closed and sutured at the same time. In group HFCUS+stapler, HFCUS was used to locate the perforating vessels and mark the location on the body surface the operation, and the vein was anastomosed intraoperatively with a stapler. In the control group, only iliac patella line was fixed before operation, and the vein was manually sutured during operation. The clinical data of 2 groups was evaluated by comparing the time consumption of flap harvest, the vascular anastomosis, the incidence of postoperative venous crisis, and the long-term survival rate of flap. Result:In the HFCUS+stapler group, a total of 27 perforators were found before the operation, 24 perforators within 1.0 cm from the preoperative marker were actually detected during the operation, and the remaining 3 perforators were about 1.7 cm, 2.0 cm and 2.5 cm from the marker respectively, with an accuracy rate of 88.9%. HFCUS+stapler group used （63.17±7.80） min to harvest the flap, while the control group used （85.47±7.41） min HFCUS+stapler group took significantly less time than the control group（P<0.001）. The arterial anastomat time in the HFCUS+stapler group was （9.48±1.20） min and it was （9.18±1.13） min in the control group. The difference between the two groups was not statistically significant（P=0.426）. The total anastomosis time of the two veins was （14.87±2.62） min in the HFCUS+stapler group and （33.06±3.86） min in the control group. The HFCUS+stapler group had significantly less anastomosing time than the control group（P<0.001）. In HFCUS+stapler group, no arteriovenous crisis occurred after operation, and all flaps survived well 15 days after operation. In the control group, 2 cases had venous crisis after operation（P=0.091）. Conclusion:HFCUS combined with iliac patellar line can improve the accuracy of anatomical perforated vessels, reduce the time of flap harvesting, and reduce the possibility of accidental injury of perforated vessels. The use of microvascular stapler for vein anastomosis can reduce the operation time and improve the survival rate of flap. The combination of the two can significantly reduce the operation time of microsurgical repairing maxillofacial soft tissue defect, improve the operation quality, and has higher clinical application value.

Application of anteromedial thigh flap as a alternative flap in maxillofacial soft tissue defects

Objective:To explore the application value of anteromedial thigh flap（AMT） as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap（ALT） reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.

Effectiveness of Chitosan versus Collagen Membrane for Wound Healing in Maxillofacial Soft Tissue Defects: A Comparative Clinical Study

Effectiveness of Chitosan versus Collagen Membrane for Wound Healing in Maxillofacial Soft Tissue Defects: A Comparative Clinical Study

Role of fasciocutaneous supraclavicular artery flap in reconstruction of the maxillofacial soft tissue defects

Role of fasciocutaneous supraclavicular artery flap in reconstruction of the maxillofacial soft tissue defects

Autologous dermis-fat grafts in head and neck patients: Indications and evaluation in reconstructive surgery

PurposeThe aim of this study was to examine the indications and results of autologous dermis-fat grafts in the reconstruction of maxillofacial soft-tissue defects. Materials and methodsA total of 93 patients with dermis-fat graft reconstruction due to a soft tissue defect in the head and neck region were enrolled in this retrospective clinical study between March 2002 and January 2017. They were classified into the subgroups ‘parotid surgery’, ‘orbital surgery’, and ‘facial surgery’. All the patients were evaluated for wound complications, and the general indications were discussed. ResultsIn all, 96 dermis-fat grafts were performed in 93 patients. A total of 34 complications that arose in 30 patients were assessed. The dermis-fat graft was primarily transplanted in 50 cases and secondarily in 46. Of the patients, 90 showed well-integrated dermis-fat grafts. A major complication occurred in three patients. ConclusionDermis-fat grafts for the reconstruction of maxillofacial soft-tissue defects represent a reliable method with a low rate of major complications. The graft can be used as a primary as well as secondary transplant. Especially in parotid and orbital surgery, the dermis-fat graft appears to be a transplant of choice. It can also be used as an alternative in facial surgery, lip enhancement, and special individual cases.

Regional flaps in maxillofacial and oral soft-tissue reconstruction: Experiences and challenges in a developing country

Background: Maxillofacial and oral defects are complex to reconstruct because of the intricate nature of tissues. The aim of this study is to present our experience in maxillofacial and oral soft-tissue defects reconstruction using regional flaps. Patients and Methods: This is a retrospective study of maxillofacial and oral soft-tissue reconstruction (MFOSTR) in the Department of Dental and Maxillofacial Surgery of a University Teaching Hospital, northwest Nigeria, over a 4 years' period. Data such as age, sex, diagnosis, type of flap used, complications, and prognosis were collected and analyzed with IBM SPSS Statistics for Windows Version 20 (Armonk, NY, USA: IBM Corp). Results: A total of 64 MFOSTRs were performed during the study out of which 22 (34.4%) were done using regional flaps. They consist of 10 (45.5%) males and 12 (54.5%) females, with a male: female ratio of 0.8:1. Cancrum oris (17 [77.3%]) was the main indication for regional flap utilization in the MFOSTR. Deltopectoral flap (18 [81.8%]) was the most commonly used flap in our series. Other flaps used were; pectoralis major 3 (13.6%) and latissimus dorsi 1 (4.5%) flaps. Total flap failure was observed in 3 (13.6%). Conclusion: Despite personnel and infrastructure deficit in developing countries, especially sub-Saharan Africa, maxillofacial and oral reconstruction in our hospital has achieved some success. Patient selection is important for overall flap success.

Application of digital 3D imaging technique in flap design before maxillofacial soft tissue reconstruction

Objective:Using digital technique to design the preoperative flap of oral and maxillofacial soft tissue defect, to instruct the operation and to provide the basis for making the individual femoral flap. Method:We chosed 7 patients with oral and maxillofacial malignancies to undergo thin-line CT scans of lower extremities and analyzed the data of CTA examination to measure the diameter, shape and length of vascular pedicle. Then selected the appropriate perforation as the source of blood supply for flap. The location of perforation was marked on the skin to simulate flap removal range.During the surgery according to the preoperative mark, draw lines and mark flap size. After flap preparation is completed, suture the donor area directly and build in negative pressure drainage tube. Result:All reconstruction of the anterolateral femoral artery descending perforator flap can show the skin, muscle, blood vessels and their adjacent relationship, and according to the size of the defect area, using Mimics 17.0 software simulation to cut flap which should be the same as the defect area. The main perforating branches and trunks of seven skin flaps were consistent with pre-operative examination and all skin flaps survived; the wound surface and the donor were all in stage Ⅰ healing. After operation, patients were followed up for 1-6 months and the form, quality and function of skin flaps all recovered well. Conclusion:The location of lateral femoral circumflex artery descending limb and perforating branch were accurately located by digital technique three-dimensional reconstruction technology, showing the spatial relationship among skin, muscle, blood vessels and bones. By combining with Mimics 17.0 software, it can achieve three-dimensional and accurate design of anterolateral thigh flap, reduce the donor injury and improve the successful rate of skin flap.

Reconstruction of oral and maxillofacial soft tissue defects with anterolateral thigh (myocutaneous) flap assisted by computed tomography angiography

To investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects. Between January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T 2N 0M 0, 3 cases as T 2N 1M 0, 1 case as T 2N 2M 0, 4 cases as T 3N 0M 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, 2 cases as T 4N 1M 0, and 1 case as T 4N 2M 0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly. CTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N 1M 0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation. The anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.

Application of microdissected thin anterior lateral thigh flap in precise microsurgical reconstruction of oral and maxillofacial soft tissue defects

Application of microdissected thin anterior lateral thigh flap in precise microsurgical reconstruction of oral and maxillofacial soft tissue defects

Application of microdissected thin anterior lateral thigh perforator flap in precise microsurgical reconstruction of oral and maxillofacial soft tissue defects

Objective To investigate the application of microdissected thin anterior lateral thigh perforator flap (ALTP flap) in precise reconstruction of oral and maxillofacial soft tissue defects and to assess the clinical reconstruction outcome. Methods From January, 2014 to September, 2015, utilizing the technique of microdissected thin anterior lateral thigh flaps to repair the defects resulted from radical resections of primary sites in 42 patients with oral cancer. Before the operation, the dominant perforator was detected and marked on the skin where the planned flap would be harvested later by Doppler probing. Initial incision was made medial to the perforator marker. Careful dissection was conducted suprafascially to isolate the dominant perforator as well as identifying its source and type. The size of flap was determined according to the area of defect after tumor ablation. Meanwhile the flap was thinned in accordance with the contour of the defect or the organ to be reconstructed. The procedure should be performed under operating microscope. Results Forty-five microdissected thin ALTP flaps were harvested and used to reconstruct the defects of tongue, buccal, oral floor, and gingiva in 42 patients. Among them, 28 flaps were nourished by single perforator, 14 flaps were nourished by 2 perforators, and 3 flaps were nourished by 3 perforators. In total, 65 perforators were identified, in which 28 were direct cutaneous branches, 13 were fascia-cutaneous branches, and 24 were fascia branches. One take-back occurred within 6 hours due to cervical haematoma. During re-exploration, pedicle compression was found. And the flap was salvaged successfully after haemotoma removement and proper bleeding point ligation. Four flaps underwent marginal necrosis which healed smoothly after debridement and dressing changes. Post-operative 6 to 24 months’ follow-up showed satisfactory appearance of the recipient sites with favorable speech and swallowing function. All donor sites were closed primarily, leaving no donor-site complications including incision disruption, scar hyperplasia or muscle strength degeneration of the lower limb. Conclusion Microdissected thin anterior lateral thigh perforator flap is an optimal choice for personalized reconstruction of soft tissue defects of the tongue, buccal, oral floor, and gingiva, for it can decrease donor-site morbidity and achieve better appearance and function reconstruction effect of the recipient site. Key words: Oral and maxillofacial defects; Anteriolateral thigh flap, perforator flap; Microdissected thin flap; Microsurgical technigue

Clinical observation of individualized forearm flap in reconstruction of oral and maxillofacial defects

Objective To investigate the forearm flap personalized design method and the curative effect in repairing maxillofacial defects. Methods From March, 2011 to September, 2015, 16 cases with oral maxillofacial tumor and facial tissue defect were treated. There were 8 males and 8 females with an age range of 41-70 years (mean, 54 years). According to the shape and size of the defect after tumor resection in each patient, the forearm flap was designed to repair the defect. The effectiveness was evaluated after operation by observing the survival of the forearm flap transplantation, the patient’s facial appearance, the functions of speech, swallowing. Results The incision healed by first intention in this group, 16 cases of forearm flap survived. All cases were followed-up 8-36 months without tumor recurrence. The functions of speech, swallowing were basically normal. The facial appearance was satisfactory. The patients were satisfied with their appearance and functional recovery after operation. Conclusion Take personal way of forearm flap design according to maxillofacial soft tissue defect, can restore the maximum facial appearance and function of patients, improve the quality of life of patients after surgery to repair, can obtain satisfactory results. Key words: Maxillofacial defect; Radial forearm free flap; Individualization, repair; Microsurgical technique

Application of CT angiography for detecting perforator vessels in the anterolateral thigh flap surgery

Objective:To investigate the effectiveness of CT angiography for detecting perforator vessels in the anterolateral thigh flap surgery.Method:Eight patients with oral and maxillofacial soft tissue defects were repaired with the anterolateral thigh flap. Preoperative CT angiography was conducted to detect perforator vessels. The perforator vessel with large diameter, abundant blood flow, and long pedicle was selected to design the flap.Result:The position of perforator vessels during operation were completely consistent with those detected by CT angiography. The anterolateral thigh flap for 8 cases tally survived.One case had the vascular crisis，which was survived after surgical exploration. The flap ranged from 10 cm×5 cm to 6 cm×4 cm in size. Donor recipient site was not severe complications.Conclusion: CT angiography can be used to locate the perforator vessels preoperatively and accurately，which is beneficial for surgeons to design the flap and reduce surgical complications. The anterolateral thigh flap is an effective method of repairing oral and maxillofacial soft tissue defects.