Through-and-through Research Articles

Application of double-leaf perforator free flap of posterolateral calf peroneal artery in repairing facial through-and-through defect after oral cancer oblation

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation. Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies, including 4 cases of buccal mucosa carcinoma, 2 cases of maxilla osteosarcoma, 1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma, were recruited from May, 2016 to May, 2018. The flap was used to repair the facial defect of recruited patients. The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm, respectively. The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate, the skin, subcutaneous tissue and mucosa of the cheek. The radiotherapy was performed 1.0-1.5 months after the operation. The prognosis including appearance, mouth opening, and the functions of deglutition, and language were assessed. Results Through 3-18 months outpatient followed-up, all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention. The patients were satisfied with the facial appearance, mouth opening, and the functions of deglutition and language at the 6 months follow-up. The radiotherapy had no damage on the survival of the bilobed perforator flap. There was no recurrence or metastasis in follow-up. Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel, abundant tissues, flexible design and operating methods. Key words: Oral cancer; Through-and-through defect; Double-leaf perforator free flap; Peroneal artery; Repair

Fold anterolateral thigh flap in through-and-through cheek defect reconstruction following oral cancer ablation

Objective To investigate the outcome of fold anterolateral thigh flap in through-and-through defect reconstruction following oral cancer ablation. Methods From January, 2011 to December, 2013, 23 patients were performed through-and-through defect reconstruction following oral cancer ablation with free fold anteorlateral thigh flap including 15 cases of buccal mucosa carcinoma, 2 cases of basal cell carcinoma of buccal skin, 4 cases of gingiva carcinoma, 1 case of recurrent parotid duct carcinoma and 1 case of buccal rhabdomyosarcoma. The defects ranged from 3.5 cm × 7.0 cm~7.0 cm × 12.0 cm and the flaps ranged from 4.0 cm × 12.0 cm-8.0 cm × 20.0 cm in size, and were adjusted to the through-and-through defect of the buccal area. The outcome of reconstruction was evaluated by considering the facial appearance, the swallowing and the speech function, the ranges of mouth opening and patient prognosis. Results All of the 23 cases transplanted flaps survived well, the donor sites were closed directly, without donor-site morbidity. All patients were satisfactory with their facial appearance, occlusion and swallowing and speech function. Fifteen patients performed post-operative radiotherapy. The follow-up period was 8-45 months(average 22 months), 5 patients performed salvage surgery for tumor recurrence and 2 patients died of re-recurrence, 1 patient survival with disease and all other patients were alive without disease. Conclusion The fold anterolateral thigh flap is large and suitable and reliable for the through-and-through defect reconstruction following oral cancer ablation. Key words: Oral cancer; Through-and-through defect; Anterolateral thigh flap; Transplantation

Anatomy on chimeric flaps of lateral circumflex femoral vessel and application for the reconstruction of complex oral and maxillofacial defects

Objective To discuss the anatomic basis for design of chimeric flaps pedicled with lateral circumflex femoral vessel and to evaluate the feasibility of the chimeric flaps for the reconstruction of complex oral and maxillofacial defects.Methods Sixty-six patients who underwent oral and maxillofacial malignant tumor resection and reconstruction with the flaps pedicled with lateral circumflex femoral vessel from October,2008 to April,2009 in the Second Xiangya Hospital were selected as the subjects.The distribution,number,type and origin of cutaneous perforators arising from lateral circumflex femoral vessel in the anterior thigh region were explored by anatomic observation.A retrospective review was performed of 29 patients who underwent reconstruction of through-and-through oral and maxillofacial defects with chimeric flaps pedicled with lateral circumflex femoral vessel from October 2008 to October2011.The chimeric flaps were harvested to reconstruct through-and-through cheek defects in 26 cases,through-and-through defects from floor of the mouth to mental region in 2 cases,through-and-through defects of basis nasi in 1 case.Results In the 66 cases,333 cutaneous perforators originating from the lateral circumflex femoral vessel were present in the anterior thigh region (5.0 perforators per case on average; range,1 to 9).And 282 cutaneous perforators were present in the anterolateral thigh region (4.3 perforators per case on average; range,1 to 8).78.7％ of cutaneous perforators in the anterolateral thigh region derived from the descending branch of the lateral circumflex femoral artery (LCFA),19.9％ derived from the transverse branch of the LCFA,1.4％ derived from the ascending branch of the LCFA.Further,most perforators (85.5％) in the anterolateral thigh region were musculocutaneous perforators; the rest (14.5％) were septocutaneous perforators.In addition,38 cases of patients had cutaneous perforators deriving from the lateral circumflex femoral vessel in the anteromedial thigh region.Postoperatively,28 of 29 cases of chimeric flaps survived completely,providing a success rate of 96.6 percent.All patients were followed for approximately 6 to 36 months,and they were satisfied with the esthetic and functional results of the donor and recipient sites after the reconstruction.Conclusion With the convenient design of the flaps,chimeric flaps pedicled with lateral circumflex femoral vessel are suitable for the reconstruction of complex oral and maxillofacial defects. Key words: Oral and maxillofacial region; Lateral circumflex femoral vessel; Chimeric flap; Microsurgical operation

Cecal Through-and-through Penetration by Right Distal Ureter as a Complication of Ureteroneocystostomy: Report of a Case

Viscus perforation is an unusual complication of Politano-Leadbetter ureteral reimplantation. It usually occurs when the reimplanted ureter is blindly grasped without proper mobilization of the urinary bladder. A 13-month-old male baby had an operative history of intravesical right ureteroneocystostomy at age 7 months and presented with progressive right hydroureteronephrosis. At exploration, the cecum was penetrated through-and-through by the right ureter and we retroperitonealized the ureter with a double-J stenting. There was regression of right hydronephrosis on sonographic follow-up postoperatively.