Application of a modified U-shaped forearm flap for the repair of small and medium-sized defects in the oral and maxillary areas / 口腔疾病防治

Objective@#To evaluate the applicability of a modified U-shaped forearm flap for the repair of small- and medium-sized defects in the oral and maxillary areas to provide a reference for clinicians.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Ten patients with small- and medium-sized defects in the oral and maxillary areas underwent surgical repair using modified U-shaped forearm flaps. There were 8 males and 2 females aged 43-72 years. The donor site was apposed primarily after harvesting the modified U-shaped forearm skin flap. The flaps ranged from 6 cm × 4 cm to 8 cm × 5 cm in size. Six months after the operation, hand movements (finger extension, fist clenching, wrist rotation upward and wrist rotation downward), the forearm donor site, hand sensations and the satisfaction score for the postoperative quality of the scar at the donor site were evaluated (0 to 10; 0: very unattractive, 10: very satisfactory).@*Results@#A total of 10 patients with modified U-shaped forearm flaps survived. One patient developed venous crisis 24 hours after surgery and survived after surgical exploration. Delayed healing occurred at the donor site of the forearm in 1 patient, and the wounds at the donor site of the forearm in the other patients all healed in the first stage. One patient presented with dysesthesia in the hand 2 weeks after surgery and recovered within 3 months. Six months after surgery, all patients had no limited hand movement and no paresthesia at the forearm donor site or hand. The patients were basically satisfied with the appearance of the donor site,and the average satisfaction score of the subjective questionnaire was 8.4 points.@*Conclusion@#Modified U-shaped forearm flaps can directly close forearm donor site wounds, which avoids surgical trauma to the secondary donor site and significantly reduces related complications. Modified U-shaped forearm flaps provide an alternative to conventional forearm flaps for the repair of small- and medium-sized defects in the oral and maxillary areas.

Effect of tension on recovery of the donor site of a modified forearm flap / 口腔疾病防治

Objective @#To investigate the effect of tension on donor site recovery of modified forearm flaps (closed forearm donor site skin flaps).@*Methods @# From October 2018 to April 2021, 12 patients with oral cancer underwent forearm flap repair at Xuzhou Central Hospital. Handgrip strength and wrist motion were recorded before surgery. During the surgical incision at the donor site of the forearm, the triangular full-thickness skin of the donor site was used to close part of the surgical incision, and the other part of the surgical incision was directly closed and sutured. Tension was measured with a tension meter during the surgical incision at the donor site. Patients were followed up after surgery to observe whether there were postoperative complications such as necrosis and poor healing of donor site wounds, as well as forearm grip strength, wrist range of motion and appearance satisfaction.@* Results@#Among the 12 patients, there was only one elderly patient with postoperative necrosis near the wrist in the donor site skin, and the average tension of the patient was 0.65 kg; the lesion healed after dressing changes. All of the other patients recovered well without postoperative complications. The mean tension of 12 patients was (0.51 ± 0.05) kg. The preoperative and postoperative grip strength of 12 patients was (23.7 ± 10.3) kg and (22.3 ± 10.7) kg, respectively, and the difference was not statistically significant (t=5.872, P<0.001). The mean range of motion of the wrist was (47.6 ± 8.3)°, (45.8 ± 5.8)°; dorsiflexion (54.6 ± 3.2)°, (53.9 ± 2.3)°; radial deviation (37.0 ± 2.3)°, (36.1 ± 2.2)°; ruler deviation (27.1 ± 1.9)°, (26.4 ± 1.3)°, respectively. The t values were 1.64, 1.636, 2.116 and 1.412, and the P values were 0.129, 0.130, 0.058 and 0.186, respectively. All 12 patients were satisfied with the appearance of the donor site of the forearm.@*Conclusion@#When the average tension during suturing is less than 0.5 kg, there is a lower risk of complications at the donor site of the forearm one month after surgery, a lower risk of impaired donor site function, and a greater possibility of patient satisfaction with the appearance of the donor site.

Application of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection / 中华肿瘤杂志

Objective: To evaluate the effect of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection. Methods: From June 2016 to December 2019, 12 patients with defect after resection of mouth floor cancer were treated with trifoliate flap design of radial forearm flap. All of these patients were T2 stage, included 9 well-differentiated squamous cell carcinoma (SCC) and 3 moderate differentiated SCC. The defect size ranged from 8.0 cm×6.0 cm to 5.0 cm×4.5 cm after resection of tumor and neck dissection. All defects were repaired with trifoliate flap design of radial forearm flap. The flap size ranged from 8.0 cm×2.0 cm to 4.0 cm×1.5 cm, the donor site was sutured directly on Z plasty. Results: All flaps completely survived well. Both the wound and the donor site were stage Ⅰ healing. With the average follow-up of 38.6 months, the swallowing and speech function were satisfactory. Conclusions: Trifoliate flap design of radial forearm flap can effectively repair the postoperative defect of mouth floor cancer, and the donor site can be directly sutured on Z plasty. This technique can avoid forearm scar caused by skin grafting and the formation of the second donor site.

Reconstrucción lingual con colgajo libre radial: A propósito de un caso

Resumen El cáncer de lengua es una patología con una importante morbilidad e impacto en la calidad de vida del paciente, afectando la masticación, deglución, comunicación y gusto, por lo que requiere de un equipo multidisciplinario para establecer la rehabilitación adecuada. Se necesita realizar resecciones amplias para asegurar márgenes negativos, y si el cirujano considera que existe un volumen remanente insuficiente para obliterar la cavidad oral, la realización de un colgajo será necesario para mantener la función deglutoria. Se presenta el caso de un paciente de 76 años, masculino, con antecedentes de tabaquismo suspendido hace 23 años, que presenta una lesión ulcerada dolorosa en el borde derecho de la lengua móvil, la biopsia informa un carcinoma epidermoide, etapificado T2N0M0, por lo que se decide realizar hemiglosectomía derecha más disección cervical y reconstrucción con colgajo libre radial.

Abstract Tongue cancer is a pathology with significant morbidity and impact on the quality of life of the patients. It affects chewing, swallowing, communication, and taste. Therefore, a multidisciplinary team is required to establish adequate rehabilitation. Extensive resections are needed to ensure negative margins. If the surgeon considers that there is insufficient remaining volume to obliterate the oral cavity, flap surgery will be carried out to maintain the swallowing function. We present a case report of a 76-year-old male patient with a history of smoking cessation of 23 years. He presents a painful ulcerated lesion on the right edge of the mobile tongue. The biopsy reports an epidermoid carcinoma, staged T2N0M0 which led to perform a right hemiglosectomy, cervical dissection, and reconstruction with free radial forearm flap.

Application of a new V-shaped forearm flap in reconstruction of buccal cancer / 中华显微外科杂志

Objective:To design a new V-shaped forearm flap and to investigate the possibility of direct donor site closure and its value in the reconstruction of soft tissue defect after resection of buccal carcinoma.Methods:The new V-shaped forearm flap technique was applied in 10 patients with buccal carcinoma from October, 2018 to September, 2019. There were 6 males and 4 females aged from 35 to 63 years (48.3 years in average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing and the appearance forearm were recorded and evaluated three months after the surgery. Radial deviation angle, wrist flexion, ulnar deviation and dorsal extension were measured and calculated 3 months after the surgery. The wrist function was evaluated according to the Gartland-Werley scale. The recovery of wrist function was evaluated by comparing with the preoperative data.Results:Forearm donor sites were successfully closed without skin grafting in all 10 patients. Skin ischemia caused by excessive tension was observed at the incision edge in 3 patients, therefore leading to skin exfoliation and pigment loss without affecting wound healing. All patients were presented a cosmetic outcome during the follow-up period. No scar hyperplasia was observed. No significant difference was observed in perioperative wrist flexion angle, dorsal extension angle, radial deviation angle, ulnar deviation angle ( P>0.05)[data before surgery were (57.8±1.3) °, (58.4±0.7) °, (18.2±0.5) °, (28.5±1.1) ° respectively, and data 3 months after surgery were (53.2±2.1) °, (55.3±1.8) °, (16.4±0.4) °, (25.4±1.4) ° respectively]; Excellent and good rate of Gartland-Werley wrist score before and after surgery were both 100%. Conclusion:The new V-shaped free forearm flap can directly close small to medium forearm flap donor site. This method could avoid the trauma and complications of traditional free skin graft. The postoperative appearance on donor site is satisfactory and will not have adverse effects on wrist function. The new V-shaped free forearm flap is a novel method for repair of the defect of soft tissue defect after buccal cancer and it is worth to be applied in clinical practice.

Functional Assessment: Speech and Swallowing Outcomes after Free Radial Forearm Reconstruction for Hemiglossectomy Defects

Background: To evaluate the speech and swallowingoutcomes after free radial forearm reconstruction forhemiglossectomy defects.Patients and Methods: The clinicopathologic data of 10tongue carcinoma cases hospitalized from November 2015 toDecember 2018 in American International Institute of MedicalSciences, Udaipur (Raj.). There were 7 male patients and 3female patients with age ranging from 40-65 years old. Thesepatients underwent simultaneous hemiglossectomy andintraoral defects reconstruction with Forearm Radial Free flap.Mandible was not resected in any of the patients. All subjectswere evaluated 3 months postoperatively.Results: There was vascular crisis in 1 case, and secondarytreatment was taken to rescue the flap. The donor sites wereclosed with grafted skin. In 3 cases, a partial grafted skin losswas observed and the donor sites healed after a long timeunder local wound care. 2 cases suffered from numbness infingers to some degree.Conclusion: When compared with primary closure of the postexcisional defect of the tongue, it is better to reconstruct thedefect with free radial forearm flap. The overall satisfaction ofthe patients in regards to function and cosmesis in tonguereconstruction was high when using free tissue transfer in theform of free radial forearm flap following wide localoncosurgical resection

Clinical application of the bilateral radial forearm flap for tongue cancer reconstruction / 中华口腔医学杂志

The forearm radial flap is a reliable flap for the repair of the defect caused by tongue cancer resection. The clinical data of 11 tongue cancer patients that received this surgery were retrospectively analyzed. The clinical application of this technique is preliminarily discussed.

Comparison of the subjective satisfaction of free radial forearm flap and anterolateral thigh flap for the donor site after surgical reconstruction in tongue cancer patients / 天津医药

Objective To compare the subjective satisfaction of the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) of the donor site after surgical reconstruction for tongue cancer. Methods A total of 121 consecutive patients underwent FRFF or ALTF reconstruction after ablative surgery for untreated, primary tongue squamous cell carcinoma at Tianjin Stomatological Hospital and Peking University School and Hospital of Stomatology from August 2011 to October 2014 were enrolled in this study. The subjective satisfaction of the donor site, including sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life (QOL), was assessed by a self-established donor site morbidity questionnaire from October 2016 to January 2017. Results Of the 121 patients, 34 died because of cancer or other diseases, 2 were excluded because of recurrence after reconstruction surgery, 11 lost to contact, and 74 (61.2％) completed the questionnaires finally, which included 39 patients in FRFF group and 35 patients in ALTF group. The scores for sensibility, cosmetics, general impacts on the QOL and composite score were significantly higher in ALTF group than those of FRFF group (P<0.05). No significant differences were found in the movement disabilities and social activities between the two groups (P > 0.05). Conclusion ALTF has the advantage of better results of donor site morbidity, less adverse effect on the general QOL, and higher subjective satisfaction.

Comparative study of donor site complications between the medial sural artery perforator flap / 口腔疾病防治

Objective@#To demonstrate the advantages of performing medial sural artery perforator flap compared with forearm flap. @*Methods @# Between April 2010 and April 2011, 20 clinical cases were reconstructed using the medial sural artery perforator flap technique and compared with 20 forearm flap cases. Data on recent complications (in 2 weeks) and late complications (after 3 months) were collected. @*Results @#Of the 20 medial sural artery perforator flaps, Only 1 case needed a skin graft, while 19 cases were primarily closed, and 1 case occurred muscle necrosis. Only linear scar was found in the postoperative donor area, and the effect on appearance and function was slight. Of the 20 forearm flaps, all cases needed a skin graft. For the recent complications, 3 cases of effusion under the skin graft, 2 cases of partial necrosis and 2 cases of wound dehiscence were observed. For the late complications of the forearm, 16 cases of an abnormal sensation were observed in the forearm group and 5 cases of an abnormal sensation were observed in the medial sural artery perforator flap group, and these differences were statistically significant (P <0.05). Significant differences were not observed in the other subjective contrasts(P >0.05). Scarring and pigmentation were much more serious in the forearm cases than the medial sural artery cases (P <0.05), and significant differences in the functional objective examination results were not observed between the two groups (P >0.05). @*Conclusion @#The medial sural artery perforator flap represents a good alternative for oral and maxillofacial reconstructions of small- and medium-sized defects, and it presents advantages over the forearm flap since it has less donor-site morbidity.

Optimized reconstruction of oral and maxillofacial defects with common soft-tissue free flaps / 口腔疾病防治

@#Severe tissue defects in the oral and maxillofacial region are commonly caused by tumor resection and trauma and can impair physiological function and aesthetics in patients. Applying a soft-tissue free flap transfer may avoid exposing important blood vessels and nerves and restore basic anatomical structures and facial features. However, the outcomes of soft-tissue free flap transfer have tended to be unsatisfactory because of the exquisite anatomical structure and complicated functions of the oral and maxillofacial region. Therefore, it is clinically important to choose a proper reconstructive method based on specific tissue defects and to optimize the processes involved in the designing and harvesting of soft-tissue free flaps. In this review, we summarize the application of soft-tissue free flaps in oral and maxillofacial defects and strategies for optimizing the quality of tissue reconstruction.

Experiencia en microcirugia reconstructiva en el Servicio de Cirugía Plástica del Hospital Solca Quito Solón Espinosa Ayala / Experience in reconstructive microsurgery at the Plastic Surgery Service of Solca Quito Hospital Solon Espinosa Ayala

Introducción: la microcirugía desde sus inicios en los años 60s ha tenido un avance importante, ha ganado popularidad y es aceptada en la reconstrucción de tejidos blandos y óseos, ya que se pueden resolver defectos antes imposibles de reconstruir. Materiales y métodos: se realizó un estudio retrospectivo observacional de 161 casos de reconstrucción microquirúrgica en pacientes sometidos a cirugía ablativa por cáncer, en el Hospital Solón Espinosa Ayala "SOLCA" Quito durante el período 2011 y 2016 por un solo cirujano plástico y reconstructivo. Es el primer estudio que analiza el éxito en colgajos microvascularizados con reporte de 161 casos en el Ecuador. Resultados: en un total de 161 pacientes, se realizó 161 reconstrucciones con colgajos microquirúrgicos, encontrando una tasa de éxito del 95,65%, complicaciones mayores en 3,11% y complicaciones menores en 21,74%. Conclusiones: la transferencia de tejido libre ha revolucionado la reconstrucción de defectos complejos de diversa etiología, la tasa presentada de éxito en reconstrucciones microquirúrgicas es similar a las descritas internacionalmente. (AU)

Introduction: Microsurgery since its inception in the 60s has had a major breakthrough, has gained popularity and is accepted in the reconstruction of soft tissue, as can be solved by this technique to reconstruct defects previously impossible. Materials and methods: An observational retrospective study of 161 cases of microsurgical reconstruction was performed mainly in patients undergoing ablative cancer surgery, especially in the Solón Espinosa Ayala Hospital "SOLCA" Quito between the period 2011 and 2016 by a single plastic and reconstructive surgeon it is the first study that analyzes the success in microvascular flaps with report of 161 cases in Ecuador. Results: A total of 161 patients, 161 reconstructions were performed with microsurgical flaps, finding a success rate of 95.65%, major complications in 3.11% and minor complications by 21.74%. Conclusions: free tissue transfer has revolutionized the reconstruction of complex defects of diverse etiology, the success rate in microsurgical reconstructions is not related to increased surgeon experience, but with inherent talent. (AU)

Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps.</p><p><b>METHODS</b>The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t-
test to perform statistical analysis with SPSS 19.0 statistical software package.</p><p><b>RESULTS</b>Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation.</p><p><b>CONCLUSIONS</b>Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.</p>

Comparison of the quality of life between patients underwent reconstruction after hemiglossectomy using infrahyoid myocutaneous flap and radial forearm flap / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.

Application of lateral arm flap in the repair of oral and maxillofacial defects / 实用口腔医学杂志

Objective:To investigate the value of the lateral arm free flap (LAFF)in the repair of oral and maxillofacial defects af-ter resection of malignant tumor.Methods:22 cases received LAFF from January 2012 to December 2012 were studied.The flap size,preparation time,vessel diameter,anastomosis time,survival situation,success rate and postoperative results were observed. Results:The flap ranged from 14 cm ×8 cm to 6 cm ×4 cm.All flaps survived well without vascular crisis.Repair results were satis-factory.Conclusion:LAFF,with constant anatomy and simple preparation,can be applied in the repair of oral and maxillofacial de-fects after tumor resection.

Perioperative nursing for patients undergoing mandibular defect repair by forearm flap composite fibula flap / 现代临床护理

Objective To summarize the perioperational nursing strategies for patients undergoing mandibular defect repair by forearm flap composite fibula flap.Methods From January 2009 to December 2012,9 patients with mandibular defect and soft tissue defects after resection of malignant tumors received fibula flap and forearm flap.Before operation,the patient received psychological education and the preparation of donor flap and receptor area together with oral preparation was performed.After operation,the vital signs and blood circulation in the flap were observed.Results The fibula and forearm flaps in 8 patients survived.The fibula flap in one patient survived while the forearm flap developed with vascular crisis.The success rate for the transplanted flap was 89.9%. Conclusion The perioperative nursing strategies are key to increase survival rate of flaps and the success rate of operation.

Expanded random forearm flap for total nasal reconstruction in patients with cicatricial nasal deformity / 中华医学美学美容杂志

Objective To explore the method of total nasal reconstruction when the forehead skin for expanding is unavailable.Methods According to the principle of total nasal reconstruction,total nasal scar and deformity were repaired with expanded random forearm falp.All the expanders were placed in flexor side of forearm.The incision sides were placed in proximal,distal,or lateral part of the forearm according to different pedicles.After expansion,the nares were enlarged,eversion of ala nasi corrected,the contracture scars sufficiently released,and the size and shape of the reconstructive nose designed according to face size.The scar of nasal dorsum and capsule of the expanded flap could be used for reconstructing nasal dorsum.Donor sides could be sutured directly,the pedicle could be cut 3 weeks later.Results All the flaps survived with good appearances,and 3 of the 15 cases with proximal,11 with distal,and 1 with lateral pedicle.The effect of distal pedicle group was better than that in proximal and lateral pedicle group because of comfortable posture longer pedicle,and providing more tissue for reconstruction.Conclusions Total nasal reconstruction with expanded random forearm flap is an option when the forehead skin for expanding is unavailable.

Lower Eyelid Full-Thickness Reconstruction Using a Radial Forearm Free Flap with Palmaris Longus Tendon Sling: A Case Report

PURPOSE: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. METHODS: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a 5 x 8 cm radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. RESULTS: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. CONCLUSION: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Comparison of anterolateral thigh flap and forearm flap in repair of head and neck defects / 中华显微外科杂志

Objective To report the clinical results and the advantages/disadvantages of anterolateral thigh flap (ALT) and forearm flap (FAF) in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential bypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantsges and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which 1 flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site deponds on situation of the defect and purpose of the reconstruction.