Young Adam M H, Bache Sarah, Segaren Nicolas, Murphy Suzane, Maraka Jane, Durrani Amer J
Department of Plastic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
Front Surg. 2019 Dec 20;6:53. doi: 10.3389/fsurg.2019.00053. eCollection 2019.
Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. The majority of patients received an ALTFF ( = 56) with 38% receiving a RFFF ( = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative ( = 0.021) in addition a reduction in the number of days in ITU ( = 0.01) and post-operative clinic visits ( = 0.025). We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.
手术切除口腔内恶性肿瘤是一种成熟的主要治疗方式。该区域对组织的需求是一块薄而柔韧、体积最小的皮瓣，历史上一直通过桡侧前臂游离皮瓣（RFFF）进行游离组织移植来提供。最近，有文献描述了股前外侧游离皮瓣（ALTFF）的作用，尽管在饮食习惯西化的人群中，相对于桡侧前臂游离皮瓣，由于皮瓣厚度问题，身体形态可能会妨碍使用ALTFF。对2008年7月至2016年4月期间在阿登布鲁克医院由资深作者进行即刻软组织重建的90例连续口腔内恶性肿瘤患者的数据进行了回顾性分析。排除需要骨重建的病例。记录患者的年龄、性别、手术指征、肿瘤位置和缺损类型、并发症、成功率以及住院时间。大多数患者接受了ALTFF（n = 56），38%的患者接受了RFFF（n = 34）。手术切除最常发生在口底。分别用ALTFF和RFFF封闭41次和28次。RFFF组的成功率为97%；有1块皮瓣发生部分坏死，需要完全修复。在ALTFF组中，皮瓣成功率为100%。使用ALTFF导致术中次数减少（P = 0.021），此外重症监护病房（ITU）天数减少（P = 0.01），术后门诊就诊次数减少（P = 0.025）。我们展示了一组主要使用ALTFF重建西方人群鳞状细胞癌切除术后口腔缺损的病例。结果表明，这种治疗在该人群中至少能产生与使用RFFF修复相当的效果，同时避免了RFFF供区的并发症和美观问题。
