Microvascular reconstruction of extended total lip defects

Sensory recovery and oral health-related quality of life following tongue reconstruction using non-innervated radial forearm free flaps

OBJECTIVES

This study aimed to monitor the recovery of somatosensory function and oral health-related quality of life after tongue reconstruction using a non-innervated radial forearm free flap (RFFF).

METHODS

Twenty patients (9 men, age: 42-67 years) underwent tongue reconstruction with non-innervated RFFFs, and twenty age- and sex-matched controls were included in this study. Quantitative sensory testing (QST), including cold, warm, and mechanical detection thresholds (CDT, WDT, MDT); cold, heat, and mechanical pain thresholds (CPT, HPT, MPT); and static two-point, sharp/blunt, and direction discrimination (S2-PD, S/BD, DD) were determined 9 months and 18 months after surgery on the surgical (9 M, 18 M) and contralateral sides (9Mc, 18Mc). Oral Health Impact Profile-49 (OHIP-49) was used to determine the oral-related quality of life of participants.

RESULTS

All parameters showed significantly lower sensitivity at 9 M and 18 M (p < 0.001) compared to those for the controls and the contralateral side, except for DD (p = 0.101). In addition, the parameters showed a significant decrease in sensitivity for 9Mc and 18Mc (p ≤ 0.043) compared to those for the controls, except for MPT, HPT, S/SD, and DD (p ≥ 0.453). Findings on WDT, MPT, S2-PD, and DD (p ≤ 0.046) indicated significantly higher somatosensory function at 18 M than that at 9 M. MDT and MPT (p ≤ 0.038) showed significantly higher sensitivity at 18Mc than at 9Mc. Scores for all dimensions of OHIP-49 were significantly higher in patients (decrease in quality of life, p ≤ 0.002) than in controls, except for physical discomfort (p = 0.51). However, the scores were significantly higher at 18 M than at 9 M (p ≤ 0.011), except for handicap (p = 0.36). Postoperative chemotherapy was significantly correlated with impaired thermal sensitivity of the flaps (WDT, p = 0.049).

CONCLUSION

The present findings showed significant impairment in somatosensory function on both the surgical and contralateral sides of patients with RFFFs. However, a significant increase in somatosensory function was observed on both sides over time. Somatosensory disturbances observed after surgery were associated with poor oral health-related quality of life.

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

Background

To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap.

Material and Methods

The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery.

Results

Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05).

Conclusions

Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity.

Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity.

Reconstruction of extensive lip and perioral defects after tumor excision

OBJECTIVE

The purpose of this study was to assess the clinical features, treatments, and results of extensive lip and perioral defects after tumor excision.

METHODS

This is a retrospective study of patients with extensive lip and perioral defects who underwent surgical interventions during the 7-year period from April 2005 to April 2012. The reconstructive procedures of lip and perioral defects were mainly performed with regional flaps or free flaps.

RESULTS

Eleven patients with extensive lip and perioral defects were identified, and immediate lip and perioral defects reconstruction was performed with the folded free radial forearm flap in 2 patients, the free radial forearm flap and the forehead island flap in 1 patient, the pectoralis major myocutaneous flap in 2 patients, the submental island flap and the nasolabial flap in 1 patient, the folded thinned anterolateral thigh flap in 4 patients, and double skin paddle anterolateral thigh flaps and adjacent flap in 1 patient. All patients had good oral competence, and the cosmetic results were acceptable.

CONCLUSIONS

Reconstruction of extensive lip and perioral defects after tumor excision is a challenge for the plastic surgeon. It should take into account the patient's condition, local tissue characteristics, previous treatments, functional needs, cosmetic aspects, and so on. The surgeon might need to reconstruct the lip with regional flaps or free flaps.