Wu Limeng, Chen Jie, Tian Tian, Li Ning, Jiang Canhua
Resident, Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China.
Associate Professor, Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China.
J Oral Maxillofac Surg. 2020 Jul;78(7):1203-1213. doi: 10.1016/j.joms.2020.02.033. Epub 2020 Mar 14.
Radical resection of buccal carcinoma frequently leads to intraoral or through-and-through buccal defects. Anterolateral thigh (ALT) flaps can be harvested to reconstruct different buccal defect subtypes. The purpose of this study was to investigate clinical outcomes after the application of personalized ALT flaps for the precise reconstruction of unilateral buccal defects.
Patients with primary unilateral buccal carcinoma who underwent tumor ablation and simultaneous reconstruction of personalized ALT flaps from January 2015 to January 2018 were enrolled in this retrospective case series. Buccal defects were classified into 4 subtypes. Demographic features, defect range and reconstructive method, and perioperative characteristics were reviewed and recorded. Quality of life and mouth opening were assessed by the University of Washington Quality-of-Life questionnaire and interincisal distance (IID), respectively, during follow-up. Descriptive statistics were calculated for each study variable.
Four types of ALT flaps were harvested and used to reconstruct different buccal defects in 146 patients. Of the 193 skin paddles applied, 189 survived, and few recipient- and donor-site complications were observed. One hundred eight patients were assessed with the University of Washington Quality-of-Life questionnaire and followed until 12 months postoperatively. Our results showed that physical, functional, social, and emotional domain scores increased steadily during the follow-up period. Ninety-eight patients showed improvements in mouth opening when the IID before the operation was compared with the IID at 3 and 6 months postoperatively.
A personalized ALT flap is a suitable choice for reconstructing unilateral buccal defects after oncologic surgery given its high success rate, customizable and flexible design, low complication rate, and satisfactory esthetic and functional results.
颊癌根治性切除术后常导致口腔内或贯通性颊部缺损。可采用股前外侧（ALT）皮瓣修复不同类型的颊部缺损。本研究旨在探讨应用个性化ALT皮瓣精确修复单侧颊部缺损后的临床效果。
本回顾性病例系列纳入了2015年1月至2018年1月期间接受肿瘤切除并同时进行个性化ALT皮瓣修复的原发性单侧颊癌患者。颊部缺损分为4种类型。回顾并记录患者的人口统计学特征、缺损范围及修复方法、围手术期特征。随访期间分别采用华盛顿大学生活质量问卷和切牙间距离（IID）评估生活质量和开口度。对各研究变量进行描述性统计分析。
共采集4种类型的ALT皮瓣，用于修复146例患者不同类型的颊部缺损。193个皮瓣中，189个存活，受区和供区并发症较少。108例患者采用华盛顿大学生活质量问卷进行评估，并随访至术后12个月。结果显示，随访期间身体、功能、社会和情感领域的评分稳步提高。98例患者术前IID与术后3个月和6个月的IID相比，开口度有所改善。
个性化ALT皮瓣成功率高、设计可定制且灵活、并发症发生率低、美学和功能效果满意，是肿瘤切除术后修复单侧颊部缺损的合适选择。
