Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS, B3H 4R2, Canada.
Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada.
J Otolaryngol Head Neck Surg. 2020 Oct 20;49(1):75. doi: 10.1186/s40463-020-00468-9.
The submental island flap (SIF) is a reliable option for reconstructing defects in the facial region and offers several advantages when compared to free-flap alternatives. While the reconstructive applications of the SIF have been demonstrated in the lower face, there are limited reports on its utility as a composite flap for reconstructing defects of the upper facial skeleton. To our knowledge, we report the first cases of composite (osteocutaneous) SIFs used for reconstruction of complex facial defects involving the zygoma and lateral orbit respectively.
Three consecutive cases are presented. All were performed following resection of skin cancers with invasion of the upper facial skeleton. The first case was a 68-year-old male with a longstanding history of non-melanoma skin cancers who presented with a 7 cm recurrent basal cell carcinoma (BCC) with bicortical invasion of the left zygoma. The second case was an 88-year-old female with several squamous cell carcinomas (SCC), including a dominant 7.1 cm SCC on the right temple with orbital invasion. A third case was a 75-year-old immunosuppressed male with a 6.5 cm SCC of the right cheek with invasion of the orbit and zygoma following prior resection as well as high dose radiotherapy. The operative management of all cases involved harvesting the SIF on its vascular pedicle alongside the inferior portion of the mandible with rigid fixation to address the bony defects. The first case was robust throughout adjuvant radiotherapy with no flap complications after 2 year follow up. The second patient received adjuvant radiation therapy to an area that was previously radiated. Although the flap remained viable for a year, the patient experienced delayed soft tissue loss over the bony segment and eventual devitalization of the distal flap. The third case achieved a satisfactory result with no complications.
Our case series outlines a unique application of the composite (osteocutaneous) submental island flap (SIF) for reconstruction of complex facial defects involving the upper facial skeleton. The osteocutaneous SIF should be used with caution in patients receiving adjuvant radiotherapy who have a history of previous radiation to the same or overlapping field.
颏下岛状皮瓣（SIF）是一种可靠的用于重建面部区域缺损的方法，与游离皮瓣相比具有多种优势。尽管 SIF 的重建应用已在下面部得到证实，但关于其作为复合皮瓣用于重建上颌骨缺损的报道有限。据我们所知，我们报告了首例用于重建涉及颧骨和外侧眼眶的复杂面部缺损的复合（骨皮）SIF 病例。
连续报告了 3 例病例。所有病例均在切除侵犯上颜面骨骼的皮肤癌后进行。第 1 例为 68 岁男性，长期患有非黑色素瘤皮肤癌，表现为左侧颧骨有 7cm 长的复发性基底细胞癌（BCC），有双皮质侵犯。第 2 例为 88 岁女性，患有多个鳞状细胞癌（SCC），包括右颞部有 7.1cm 主导 SCC 伴眼眶侵犯。第 3 例为 75 岁免疫抑制男性，右侧脸颊有 6.5cm SCC，伴有眼眶和颧骨侵犯，先前切除后接受了高剂量放疗。所有病例的手术管理均涉及在颏下血管蒂旁和下颌骨下部同时采集 SIF，并进行刚性固定以解决骨缺损。第 1 例患者在接受辅助放疗期间表现稳健，2 年随访后无皮瓣并发症。第 2 例患者接受了先前接受过放疗的区域的辅助放疗。尽管皮瓣在 1 年内仍保持存活，但患者在骨段上经历了迟发性软组织丢失，并最终导致远端皮瓣失活。第 3 例患者获得了满意的结果，无并发症。
我们的病例系列概述了复合（骨皮）颏下岛状皮瓣（SIF）在重建涉及上颌骨复杂面部缺损的独特应用。在接受辅助放疗且有同一或重叠区域既往放疗史的患者中，应谨慎使用骨皮 SIF。
