FUNCTIONAL RECONSTRUCTION OF SOFT TISSUE OROFACIAL DEFECTS WITH MICROVASCULAR GRACILIS MUSCLE FLAP.

INTRODUCTION: Free flap reconstructive surgery of middle size and large oral and facial defects enables aesthetic and functional rehabilitation. Microvascular flap reconstructive surgery, with flap survival success rate more than 90-98%, is a gold standard in head and neck extensive reconstructions. Currently, head and neck reconstructive surgery is focused not only on defect occlusion and adequate aesthetical result, but the same emphasize is aimed at functional result. Functional result post tongue and lip resection means defect occlusion with the possibility of movement restoration. Free gracilis muscle flap appears to be a choice for functional tongue and lip reconstruction. MATERIAL AND METHODS: We present 1-year experience with 5 microvascular flap functional reconstructions of middle size and large defects of tongue and lip with free gracilis muscle flap. Four patients post tongue resection and one post subtotal lower lip and cheek resection underwent immediate functional microvascular gracilis muscle flap reconstruction. RESULTS: All five patients were successfully reconstructed with functional free gracilis muscle flap, with no flap loss. We found gracilis muscle flap harvest is not technically demanding, provides adequate tissue volume for middle size orofacial defects reconstruction, with possibility for skin island harvest, and simple primary closure of donor site with very low morbidity. Patients after tongue reconstruction with free gracilis flap were swallowing spoon ood 1 week post operation. Patient after total lip resection and immediate reconstruction with free gracilis flap presented with oral competence before the discharge. The functional result in the group of patients with free gracilis flap reconstruction for orofacial defect will have to be further evaluated again after 2 years post operation considering the ability to swallow and articulate during the speech for the tongue reconstructions and the oral competence and facial mimic for the lip reconstruction. CONCLUSION: Microvascular gracilis muscle flap reconstruction compared to radial forearm flap reconstruction enables functional reconstruction of soft tissue defect. Functional reconstruction of soft tissue defects of tongue or lip with microvascular gracilis muscle flap appears to have advantage of adequate volume, very low donor side morbidity and expectancy of movement renewal compared to other microvascular flap reconstructive options such as anterolateral thigh flap, superficial circumflex iliac artery perforator flap, lateral arm free flap or deep inferior epigastric perforator free flap.

[Effectiveness of cisplatin with continuous infusion of 5-fluorouracil in neoadjuvant chemotherapy of carcinoma of the oral cavity]. / Efektivita cisplatiny s kontinuálnou infúziou 5-fluorouracilu v neoadjuvantnej chemoterapii karcinómov ústnej dutiny.

The effect of neoadjuvant chemotherapy regimen utilizing cisdiaminodichloroplatinum (CDDP) with continuous 5-day infusion of 5-fluorouracil (5-FU) was analyzed during the treatment of 23 patients with histologically established epidermoid carcinoma of the oral cavity. All but four patients were in clinical stage III or IV of the disease and seven of them had an inoperable tumor. No one had been treated previously. Complete response after three courses of the chemotherapy was obtained in 13 patients (56.5%) and partial response in 8 (34.8%). The overall response amounted to 91.3%. Only two tumors showed no response to the therapy after one and two courses respectively. The former patient did not continue the chemotherapy due to toxicity and the latter because of its minimal effect. During therapy the disease did not progress in any of the patients studied. Neoadjuvant chemotherapy with CDDP and continuous 5-FU infusion lasting 120 hours was found to be both tolerable and an effective part of the complex management of oral cavity carcinoma without the risk of delaying subsequent definitive treatment. (Tab. 9, Ref. 18).

[Toxicity of cisplatin with continuous infusion of 5-fluorouracil in neoadjuvant chemotherapy of carcinoma of the oral cavity]. / Toxicita cisplatiny s kontinuálnou infúziou 5-fluorouracilu v neoadjuvantnej chemoterapii karcinómov ústnej dutiny.

The intensity and dynamism of the toxicity of the neoadjuvant chemotherapy regimen utilizing cis-diaminodichloro-platinum (CDDP) with continuous 5-day infusion of 5-fluorouracil (5-FU) was recorded and analyzed during the treatment of 23 patients with histologically established epidermoid carcinoma of the oral cavity. The most frequent sign of toxicity was leukopenia and nausea/vomiting, both occurring in 78% of cases. Leukopenia was more frequent and serious than reported in other studies. On the contrary, nephrotoxicity was mild and less frequent (17%) compared to literary data. Diarrhea was associated with the administration of CDDP in 31%, minimal hair loss was recorded in 21% of cases. Other signs of toxicity were rare and mild. The degree of severity of toxicity was increasing with the number of treatment courses only with respect to hematologic parameters. No life-threatening complications were recorded. In seven cases continuous treatment had to be interrupted after three days due to leukopenia. With regard to toxicity, the applied treatment schedule (three courses) is fully acceptable, safe and suitable as neoadjuvant chemotherapy in the complex management of oral cavity carcinoma without the risk of delaying subsequent definitive treatment.