Oral and Oropharyngeal Reconstruction with a Free Flap

Extensive surgical resection of the aerodigestive track can result in a large and complex defect of the oropharynx, which represents a significant reconstructive challenge for the plastic surgery. Development of microsurgical techniques has allowed for free flap reconstruction of oropharyngeal defects, with superior outcomes as well as decreases in postoperative complications. The reconstructive goals for oral and oropharyngeal defects are to restore the anatomy, to maintain continuity of the intraoral surface and oropharynx, to protect vital structures such as carotid arteries, to cover exposed portions of internal organs in preparation for adjuvant radiation, and to preserve complex functions of the oral cavity and oropharynx. Oral and oropharyngeal cancers should be treated with consideration of functional recovery. Multidisciplinary treatment strategies are necessary for maximizing disease control and preserving the natural form and function of the oropharynx.

The Versatility of the Anterolateral Thigh Perforator Flap in Oral Cavity Reconstruction After Cancer Ablation Surgery

Various vascularized flaps have been used for oral reconstruction after ablative cancer surgery. Among these, the radial forearm flap, rectus abdominis flap and anterolateral thigh perforator flap are the most popular options. In cases of tongue and mouth floor reconstruction, radial forearm fasciocutaneous flap has been the empirical choice for many years. However, it often carries cosmetic and functional problems on the donor site and limitations in flap size and volume. Considering these drawbacks, the anterolateral thigh perforator flap could be a good alternative. Generally, anterolateral thigh perforator flap has been used for tongue reconstruction due to the favorable flap thickness compared to the radial forearm flap. Furthermore, if a thin flap should be required solely for lining purpose, the flap thickness can be controlled through thinning procedures without circulatory compromise. For large composite tissue defects after cancer ablation surgery, the flap can be designed in a 3-dimensional plane and used for volumetric reconstruction as well as for adequate lining. Between September 2002 and September 2003, the authors used 15 anterolateral thigh perforator flaps for reconstruction of oropharyngeal defects after cancer ablation surgery in 15 patieints and analyzed the clinical data acquired retrospectively. Based on the results, we propose the indications and drawbacks of the anterolateral thigh flap in oropharyngeal reconstruction.

Design of Radial Forearm Free Flap for Oropharyngeal Reconstruction

The reconstruction of defects after the resection of oropharyngeal tumors must not only cover the defect area but also be able to recover its functional structure enabling speech and mastication. To achieve a functional reconstruction, the volume and the length of the pedicle must be suitably designed and a donor site fit for the location and size of the defect must be chosen. However, in reality, the structures in oropharyngeal tumor patients who underwent resection to classify the different defect shapes according to the resection site. Bases on the classification of oropharyngeal defects, we tried to standardize a flap design method for the different defects. We investigated 44 patients who underwent tumor resection and reconstruction surgery for oropharyngeal tumor during the past 3 years at Severance hospital. The defects were divided into 6 zones and 4 types of design methods of radial forearm free flap were standardized. Surgery was performed on 25 patients during September of 1998 to September of 1999 with modified design methods based on the standardized ones. A faster and more efficient flap design was possible due to the standardized method. It was also possible to enable a functional reconstruction in cases where the soft palate was involved without any nasal escape.

Lateral Arm Free Flap for Oral Cavity and Oropharyngeal Reconstruction / 대한이비인후과학회지

BACKGROUND: The aims of reconstruction after removal of head and neck cancer are restoration of function and aesthetics. Local flap is ideal for small size defect of head and neck and pedicled myocutaneous flap or distant flap have been used for medium or large size defect. But free flap reconstruction now is commonly used according to diversity of factors for reconstruction. OBJECTIVE: There are some kinds of free flap such as radial forearm free flap, scapular free flap, jejunal free flap, latissimus dorsi free flap, and rectus abdominis free flap. Lateral arm free flap have been occasionally reported in orthopedic operation but recently reported in head and neck and not reported in Korea. Thus we analysed outcome and advantage of lateral arm free flap. MATERIAL AND METHOD: We have been using lateral arm free flap to reconstruct patients from Dec. 1995 to Sep. 1996 which are included 6 patients who were seen with malignant lesions involving oral cavity and oropharynx. RESULT: 6 Patients included palatal cancer(1), tongue cancer(3), and tongue base cancer(2). All patients had been used lateral arm free flap for reconstruction. And they did not experience major complication. CONCLUSION: The lateral arm free flap is thin, pliable, and can be used as a sensate flap. It does not require the sacrificing of a major vessel to the arm and excellent cosmetic result can be achieved when the wound is closed primarily. So we think that the lateral arm free flap is an excellent method for medium sized head and neck reconstruction.