Joshi Poonam, Bavaskar Manasi, Shetty Rathan, Singh Arjun, Nair Sudhir, Chaturvedi Pankaj
Department of Head and Neck Surgical Oncology, Tata Memorial Centre, ACTREC, HOMI Bhabha National Institute (HBNI), Mumbai, India.
Rambam Maimonides Med J. 2024 Jul 30;15(3):e0012. doi: 10.5041/RMMJ.10526.
Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent.
This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer.
The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications.
Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.
口腔癌切除术后常导致复杂缺损，引起功能和美观方面的问题。在资源有限的高流量中心环境中，使用游离皮瓣进行最佳重建具有挑战性。因此，了解用于重建口腔癌缺损的局部皮瓣技术是明智的。
本研究是一项对2019年至2022年口腔切除术后使用局部皮瓣进行重建的前瞻性手术病例的回顾性分析。接受唇颊沟皮瓣、岛状面动脉肌黏膜（FAMM）皮瓣、颏下皮瓣、锁骨上动脉岛状皮瓣、舌骨下皮瓣或颈阔肌肌皮瓣（PMF）重建的患者纳入本分析。对符合条件的患者进行随访，以评估如经口进食等功能结果，并分析头颈癌性能状态量表。
该研究纳入了104例患者。舌是最常见的亚部位，导致大多数半舌切除术缺损，并使用唇颊沟皮瓣手术进行重建。我们系列中的颊黏膜缺损使用锁骨上皮瓣重建，而颏下皮瓣手术是下唇口角缺损的选择。分析了部分和全部皮瓣丢失、深部颈部感染以及供区并发症如感染、裂开、口腔皮肤瘘、腮腺瘘和血清肿等并发症；锁骨上皮瓣出现的并发症最多。
在某些病例中，局部皮瓣是游离皮瓣重建的替代方法，具有最佳的功能结果和最小的供区并发症。本文全面回顾了口腔癌缺损各种局部皮瓣手术的手术步骤。
