Dhondge Rajendra, Hussain Mohsina, Sharma Richa, Roy Sirshendu, Nagarkar Raj
Plastic and Reconstructive Services, HCG Manavata Cancer Centre, Nashik, India.
Head and Neck Surgical Oncology, HCG Manavata Cancer Centre, Nashik, India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5108-5112. doi: 10.1007/s12070-024-04863-w. Epub 2024 Aug 7.
Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenović A, Virag M, Uglešić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340-343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251-254); (Porcuna DV, Vintró XL, Vilas ML, Olmo AP, Ayala JM, Agustí MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263-268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published.
由于连续性丧失,下颌骨节段性切除可能会导致严重的功能和美学问题。在进行血管化骨移植的微血管转移后,下颌骨切除术后的发病率可以降至最低。尽管在过去几十年中,游离皮瓣已成为口腔缺损重建的金标准,但在某些情况下,区域性皮瓣也是一种可靠的选择,特别是对于那些社会经济地位较低和/或患有并存慢性合并症而无法耐受更长手术时间的患者。(米莱诺维奇A、维拉克M、乌格莱希奇V、阿尔伊诺维奇-拉特科维奇N(2006年)胸大肌皮瓣在头颈部重建中的应用:首批500例患者。《颅颌面外科杂志》34(6):340 - 343);(萨布里A(2003年)口咽重建:当前技术水平。耳鼻咽喉头颈外科当前观点。11(4):251 - 254);(波库纳DV、文特罗XL、维拉斯ML、奥尔莫AP、阿亚拉JM、阿古斯蒂MQ(2008年)胸大肌皮瓣。在微血管皮瓣时代其应用的演变。《耳鼻喉科文献(英文版)》59(6):263 - 268)早期口腔癌采用胸大肌肌皮瓣(PMMC瓣)重建的报道非常少。然而,在本文中,我们专门回顾了247例需要进行下颌骨边缘切除术的早期口腔癌病例以及采用PMMC瓣进行重建的情况,从而证明了即使在早期口腔癌中,它也有资格被称为“主力皮瓣”。这是一项对5年患者数据的回顾性分析,这些数据来自我们机构的数据登记册,涉及2017年4月至2022年6月期间接受下颌骨边缘切除术并采用PMMC瓣重建的247例患者。未报告皮瓣丢失情况。没有因血肿或充血而再次手术的病例。所有患者均顺利康复。尽管在这个时代,游离皮瓣在软组织重建中占主导地位,而PMMC瓣仅用于某些晚期口腔癌,但我们的研究证明它也可以安全有效地用于早期口腔癌患者。作为一种更快的手术方法,PMMC瓣重建应被视为需要进行下颌骨边缘切除术的早期口腔癌的一种有效替代方法,以应对低社会经济地区口腔恶性肿瘤患者数量不断增加的情况。据我们所知,这是有史以来发表的最大规模的数据。