Appropriate Selection of Free Flap Donor Sites for Functional Reconstruction of Intraoral Defect

ABSTRACT

As the oral cavity plays a vital role in swallowing, speech articulation and intelligibility, a variety of surgical techniques have been devised to reconstruct the intraoral defect which remains after ablative surgery. The ideal method of intraoral reconstruction has not yet been established, but microvascular free flaps have rapidly become the "gold standard" compared to other techniques, and nowadays interest is focused on the improvement of detailed function following reconstruction. The purposes of this study are to understand the main goal of reconstruction and to suggest the appropriate donor sites of free flap depending on the location and size of defects. From July 1988 to December 1999, 42 patients underwent intraoral reconstruction with various kinds of free flaps in accordance with the location nd size of defects. We divided the location of intraoral defects into tongue, mouth floor, buccal mucosa, and palate, retromolar trigone, pharyngeal wall according to the anatomical structures. We tried to select the most appropriate donor tissue for the requisites of defect area. After partial glossectomy, we used free jejunal patch flap as a first choice. Free lateral arm flap has been used to reconstruct the defect of hemi-glossectomy, and free rectus abdominis flap for the defect of total glossectomy. For the reconstructions of mouth floor and buccal mucosa, transversely designed and two skin paddles free radial forearm flaps have been used as a first choice. For the defects of palate, retromolar trigone or pharyngeal wall, free jejunal patch flap has been a first choice. The postoperative courses of these cases are uneventful. There was no orocutaneous fistula during follow up periods. The patients could recover their intelligible speech, deglutition and mastication. We conclude that appropriate selection of free flap donor site for intraoral reconstruction depending on the location and size of defects can improve detailed function and aesthetics, and enhance the rehabilitation and remaining quality of life.