Huang Min, Li Peiyao, Yang Le, Xiao Yudong, Zeng Lingchan, Su Yuxiong, Liang Yujie, Zeng Gucheng, Liao Guiqing, Zhang Sien
Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
Department of Medical Records, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2024 Jun 4;14:1393687. doi: 10.3389/fonc.2024.1393687. eCollection 2024.
To avoid the oncologic risks of ipsilateral regional flaps, this study aimed to explore the feasibility and clinical outcomes of the contralateral-based facial artery myomucosal island flap (C-FAMMIF) for oral T-T oncologic defects reconstruction.
A study of flap anatomy was conducted on 7 cadaver samples and a cohort of 24 patients who received C-FAMMIF reconstruction after malignancy resection were retrospectively researched. A balanced anterolateral thigh flap (ALT) group of 47 patients was extracted as control group using propensity score matching method. Progression-free survival (PFS), functional outcomes, and donor site complications were assessed.
Consistent blood supply and drainage through facial artery and vein with median maximum pedicle length of 106 mm supported contralateral reconstruction. The superficial vein drainage pattern indicated safer flap harvest at contralateral neck under circumstances of ipsilateral neck dissections. The pedicle and marginal facial nerve formed three anatomical patterns. The surgical management of each was described. Patients with ipsilateral pN neck accounted for 41.7% and 40.4% in the C-FAMMIF and ALT group, respectively. The 2-year PFS rate between the C-FAMMIF and ALT groups was not significantly different (88.2% in C-FAMMIF group and 84.6% in ALT group, respectively, = 0.6358). Promising recoveries were observed for swallowing function and tactile sensation. The donor sites healed upon primary closure without trismus or permanent facial palsy.
Our findings suggested that C-FAMMIF is feasible and safe for T-T oral oncologic defect reconstruction in patients with ipsilateral cN neck.
为避免同侧区域性皮瓣的肿瘤学风险，本研究旨在探讨基于对侧的面动脉肌黏膜岛状皮瓣（C-FAMMIF）用于口腔T-T肿瘤缺损重建的可行性及临床效果。
对7具尸体标本进行皮瓣解剖研究，并对24例恶性肿瘤切除术后接受C-FAMMIF重建的患者进行回顾性研究。采用倾向评分匹配法选取47例接受平衡股前外侧皮瓣（ALT）的患者作为对照组。评估无进展生存期（PFS）、功能结局及供区并发症。
通过面动脉和静脉实现稳定的血液供应和引流，蒂的最大长度中位数为106 mm，支持对侧重建。浅静脉引流模式表明在同侧颈部清扫的情况下，在对侧颈部获取皮瓣更安全。蒂与面神经边缘支形成三种解剖模式，并对每种模式的手术处理进行了描述。C-FAMMIF组和ALT组同侧pN颈部患者分别占41.7%和40.4%。C-FAMMIF组和ALT组的2年PFS率无显著差异（C-FAMMIF组为88.2%，ALT组为84.6%， = 0.6358）。吞咽功能和触觉感觉恢复良好。供区一期缝合愈合，未出现张口受限或永久性面瘫。
我们的研究结果表明，C-FAMMIF用于同侧cN颈部患者的T-T口腔肿瘤缺损重建是可行且安全的。
