Alotaibi Ahmed S, Shah Mardan Qutaiba N M, Almarghoub Mohammed A, Mahabbat Nehal A, Almarshad Felwa A, Hashem Fuad K
King Faisal Specialist Hospital and Research Centre, Department of Surgery, Plastic and Reconstructive Surgery Section, Riyadh, Saudi Arabia.
ABAS Medical Centre, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2021 Dec;89:106521. doi: 10.1016/j.ijscr.2021.106521. Epub 2021 Oct 18.
Locoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options.
A-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap.
Decreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required.
Choosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.
局部区域皮瓣，尤其是带蒂的前额外侧皮瓣，通常不用于肿瘤切除术后口腔底缺损的重建。相反，显微游离皮瓣已发展成为头颈重建的标准治疗方法。然而，在缺乏资源或其他选择的情况下，带蒂前额外侧皮瓣在口腔底重建中可能具有重要价值。
一名56岁患有多种合并症的女性，因局部晚期舌鳞状细胞癌接受了近全舌切除术、双侧肩胛舌骨上颈部清扫术和右侧下颌骨切开术。在多次尝试使用游离前外侧皮瓣、游离桡动脉前臂皮瓣和带蒂胸大肌皮瓣进行重建均失败后，最后采用了带蒂前额外侧皮瓣。
游离皮瓣优于局部区域带蒂皮瓣，尤其是在覆盖口腔缺损方面，其优点包括供区并发症减少和解剖结构可靠。对于后者，带蒂前额皮瓣血管丰富且邻近口咽缺损，可采用不同技术和改良方法。需要密切监测并优化患者状况。
应根据可用资源、专业知识和患者状况选择特定的重建方案。当其他选择不适用或失败时，带蒂前额皮瓣仍然具有重要价值。
