Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors

To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly. The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting [5.58 +/- 1.96hrs] was shorter than platysma flap [6.2 +/- 1.4hrs]. The majority of the flaps [88-93%] were taken successfully in both groups. Submental flap was associated with significantly higher patients' satisfaction regarding acceptable functional outcomes [p-value 0.027]. The mean reduction in mouth opening was significantly smaller in platysma group [0.37 +/- 0.18cms] than the submental group [0.47 +/- 0.16]. This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm2 with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes

Assessment of quality of life of oral cancer patients after reconstruction with radial forearm free flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the quality of life in patients who had resection of oral cancer and reconstruction by radial forearm free flaps.</p><p><b>METHODS</b>Quality of life of 49 patients was assessed by means of the 14-item oral health impact profile (OHIP-14) and the medical outcomes study-short form-36 (SF-36) questionnaires 12 months after operation.</p><p><b>RESULTS</b>Forty-one questionnaires were collected (84%). SF-36: the highest-scoring domain were physical role (92.9 ± 2.6) and bodily pain (82.6 ± 5.7), the lowest-scoring domain were vitality (61.5 ± 9.1), followed by role emotion (64.9 ± 6.8) and social functioning (65.2 ± 8.2). OHIP-14: the best-scoring domain were handicap (37.1 ± 15.1) and psychological disability (45.7 ± 11.9), the best-scoring domain were physical pain (64.2 ± 11.7) and functional limitation (61.9 ± 12.9).</p><p><b>CONCLUSIONS</b>Radial forearm free flaps for reconstruction of oral defects after cancer resection could significantly influence the patients' quality of life.</p>

Preoperative Doppler evaluation of vascular perforators in the anterolateral thigh flap harvest / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of Hadeco ES-1000spm hand-held doppler during the anterolateral thigh (ALT) flap harvest.</p><p><b>METHODS</b>Twenty-five patients (26 sides) with ALT flaps for head and neck reconstruction between May 2005 and May 2010 received preoperative Doppler examination for the location of the cutaneous perforators of ALT flaps. The Doppler signals and body mass index (BMI) were recorded preoperatively according to ABC system. The locations of Doppler signals and of the actual cutaneous perforators at surgery were plotted and compared. The diameter of perforators was measured.</p><p><b>RESULTS</b>One to three cutaneous perforators of the ALT flap were consistently found at specific locations. They were named perforators A, B, C from proximal to distal. Perforators A, B and C were present in 15 (58%), 24 (92%) and 20 (77%) cases and the diameter (> 0.5 mm) of A, B and C were 11/15, 22 (92%) and 8 (40%) respectively. The Doppler signal was within 0.5 cm of the actual perforator location in 85% flaps. The accuracy of Doppler decreased with increase of BMI.</p><p><b>CONCLUSIONS</b>Preoperative assessment by hand-held Doppler is useful in predicting the perforator vessels' locations and diameter although it's accuracy is limited.</p>