Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China.
Head Face Med. 2019 May 16;15(1):12. doi: 10.1186/s13005-019-0196-6.
The reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge.
This study evaluated 35 patients with buccal squamous cell carcinoma (SCC) involving the labial commissure who underwent Abbe-Estlander (A-EF), folded extended supraclavicular fasciocutaneous island (SFIF), folded pectoralis major muscle (PMMF), or folded extended vertical lower trapezius island myocutaneous (TIMF) flap reconstruction of through-and-through cheek defects involving the labial commissure following radical resection.
The A-EF and SFIF groups differed significantly (P < 0.05) from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment. The inner PMMF (median 6.3 × 4.5) and TIMF (median 9.8 × 6.7) skin paddle dimensions were larger than those of the A-EF (median 1.8 × 2.2) and SFIF (median 5.5 × 4.3) groups (P < 0.05). The outer PMMF (median 6.3 × 6.6) and TIMF (median 9.8 × 13.2) dimensions were larger than those of the A-EF (median 1.8 × 3.8) and SFIF (median 5.5 × 4.6) groups (P < 0.05). The esthetic results, orbicularis oris function, and speech function were significantly (P < 0.05) better in the A-EF group than in the SFIF, PMMF, and TIMF groups. The patients were followed for 6-38 months (median 26.8, 25.0, 22.1, and 20.8 months in the A-EF, SFIF, PMMF, and TIMF groups, respectively). At the final follow-up, 4 (80.0%) patients in the A-EF, 7 (87.5%) in the SFIF, 5 (55.6%) in the PMMF, and 5 (38.4%) in the TIMF groups were alive with no disease; 1 (20.0%), 1 (22.2%), 2 (22.2%), and 4 (30.8%) patients, respectively, were alive with disease; and 2 (22.2%) patients in the PMMF and 4 (30.8%) in the TIMF group had died of local recurrence or distant metastases at between 9 and 38 months. There was a significant survival difference in the A-EF and SFIF groups compared with the PMMF and TIMF groups (P < 0.05).
The A-EF is suitable for reconstructing defects of clinical stage II disease; the SFIF for clinical stage II or III disease; the PMMF for clinical stage III or IV; and the TIMF for clinical stage rCS III or rCS IV disease.
颊部贯穿唇联合缺损的重建，尤其是涉及癌症消融后的唇联合缺损，是一项具有挑战性的手术。
本研究评估了 35 例颊部鳞状细胞癌（SCC）累及唇联合的患者，他们接受了 Abbe-Estlander（A-EF）、折叠扩展锁骨上筋膜皮瓣（SFIF）、折叠胸大肌肌皮瓣（PMMF）或折叠扩展垂直下斜方肌岛肌皮瓣（TIMF）重建颊部贯穿唇联合缺损。
A-EF 和 SFIF 组在肿瘤临床分期和治疗类型方面与 PMMF 和 TIMF 组有显著差异（P<0.05）。内 PMMF（中位数 6.3×4.5）和 TIMF（中位数 9.8×6.7）皮瓣尺寸大于 A-EF（中位数 1.8×2.2）和 SFIF（中位数 5.5×4.3）组（P<0.05）。外 PMMF（中位数 6.3×6.6）和 TIMF（中位数 9.8×13.2）尺寸大于 A-EF（中位数 1.8×3.8）和 SFIF（中位数 5.5×4.6）组（P<0.05）。A-EF 组的美学效果、口轮匝肌功能和言语功能明显优于 SFIF、PMMF 和 TIMF 组（P<0.05）。
患者接受了 6-38 个月（A-EF、SFIF、PMMF 和 TIMF 组分别为中位数 26.8、25.0、22.1 和 20.8 个月）的随访。末次随访时，A-EF 组 4 例（80.0%）、SFIF 组 7 例（87.5%）、PMMF 组 5 例（55.6%）、TIMF 组 5 例（38.4%）患者无瘤生存；A-EF 组 1 例（20.0%）、SFIF 组 1 例（22.2%）、PMMF 组 2 例（22.2%）、TIMF 组 4 例（30.8%）患者疾病存活；PMMF 组和 TIMF 组分别有 2 例（22.2%）和 4 例（30.8%）患者在 9-38 个月时死于局部复发或远处转移。A-EF 和 SFIF 组与 PMMF 和 TIMF 组的生存差异有统计学意义（P<0.05）。
A-EF 适用于临床分期 II 期疾病的缺损重建；SFIF 适用于临床分期 II 期或 III 期疾病；PMMF 适用于临床分期 III 期或 IV 期疾病；TIMF 适用于临床分期 rCS III 或 rCS IV 期疾病。
