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Chakraborty PK, Patel S, Mulla MF, Kulkarni MM, Sheikh RA, Shukla AK. Comparison of Different Reconstruction Flap for Maxillofacial Region: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S252-S255. [PMID: 37654262 PMCID: PMC10466590 DOI: 10.4103/jpbs.jpbs_475_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Large chunks of the tissue are sacrificed during the surgical procedures for the treatment if oral cancers. Our goal was to assess the viability of "Buccal reconstruction using the anterolateral thigh (ALT) flaps, platysma myocutaneous (PM), and radial forearm free (RFF)". Material and Methods Sixty subjects were included in this investigation, and they were divided into 3 groups. The follow-up as accompanied for six months. Comparisons were made for the time for the operations, reduction in the width of the mouth opening and the survival rates of the flaps. The data that was collected for the above two parameters and compared for the significance using the ANOVA, keeping P < 0.05 as significant. Results In the subjects with the PM, the width of the mouth opening reduced comparatively greater than that of the subjects who received other two flaps. The reduction in the mouth opening in the PM was significantly greater compared to that of the ALT and RFF. Survival was greater for the groups ALT and RFF compared to PM. Time of the surgery was the greatest for the ALT and least for the PF. Conclusion The observations point to the fact that the PF requires more time than that of the other two flaps. The survival was however better for the ALT and RFF. Further research is suggested for suggesting an appropriative flap design.
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Affiliation(s)
- Pallavi Khan Chakraborty
- Department of Head and Neck Oncosurgery, Netaji Subhas Chandra Bose Cancer Hospital, Kolkata, West Bengal, India
| | - Smit Patel
- Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Misbah Farheen Mulla
- Department of Oral and Maxillofacial Surgery, SMBT Dental College and Hospital, Sangamner, Ahmed Nagar, Maharashtra, India
| | | | | | - Anuj Kishor Shukla
- Department of Dentistry, Government Medical College, Ratlam, Madhya Pradesh, India
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Evaluating Sensation Recovery in Noninnervated Free Flaps Used for Oral Reconstruction. J Oral Maxillofac Surg 2023; 81:350-357. [PMID: 36592932 DOI: 10.1016/j.joms.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Association between time and sensation recovery in noninnervated flaps remains unclear. Our goal was to evaluate the recovery of sensation in noninnervated free flaps used for oral reconstruction. MATERIALS AND METHODS A prospective cohort study was designed and consecutive patients undergoing noninnervated free flap surgery for oral reconstruction from a tertiary medical center were enrolled. The primary outcome variable was sensory recovery of light touch, pain, hot, and cold temperature. Sensory recovery was scored as per the test on the central portion and 4 peripheral sections of every flap. The Kaplan-Meier method was used to estimate the functional recovery at different time points and the association between clinicopathologic variables and sensation recovery at 24 months after surgery was analyzed using the chi-squared test and logistic regression analysis. RESULTS Eighty patients were included with a median age of 50 years. At 3 months postoperatively, no patients exhibited sensation recovery. Positive flap sensitivity began to appear mildly at 6 months postoperatively and gradually increased for at least 24 months. The 24-month sensation recovery rates of light touch, pain, and temperature were 70.0% (95% confidence interval [CI]: 59.2 to 78.9%), 42.5% (95% CI: 32.3 to 53.4%), and 33.8% (95% CI: 24.45 to 44.6%), respectively. In univariate analysis, 80.5% (95% CI: 66.0 to 89.8%) of the free radial forearm flaps showed light touch sensation recovery, which was statistically higher than 59.0% (95% CI: 43.4 to 72.9%) in other flaps (P = .036). Flap size ≤ 65 cm2 predicted better pain sensation recovery with 57.5% (95% CI: 42.2 to 71.5%) compared to 27.5% (95% CI: 16.1 to 42.8%) in flap size > 65 cm2 groups (P = .007). Logistic regression analysis confirmed flap size ≤ 65 cm2 (P = .032, odds ratio = 1.957, 95% CI: 1.034 to 4.389) and not smoking (P = .015, odds ratio = 2.564, 95% CI: 1.673-5.482) offered better sensation recovery of pain and hot temperature, respectively. CONCLUSIONS Sensation recovery in noninnervated free flaps was common and related to not smoking and flap size.
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Deva FAL, Kalsotra G, Kalsotra P, Saraf A. Tissue Transfer After Tongue Resection: Micro-Vascular Reconstruction Using Radial Artery Free Flap versus Reconstruction by Split Thickness Skin Graft in T2 Lesions of Tongue Carcinoma. Indian J Otolaryngol Head Neck Surg 2022:1-11. [PMID: 36571096 PMCID: PMC9759059 DOI: 10.1007/s12070-022-03380-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
To compare postoperative complications, functional rehabilitation, surgical outcomes of the radial artery forearm free flap (RAFFF) and split thickness skin graft (STSG) reconstruction of postsurgical defect in T2 lesions of cancer oral cavity. Observational Prospective comparative study. Academic tertiary referral centre. In our study of forty four patients, after tumour resection, half underwent reconstruction using RAFFF (Group I) and another half by STSG (Group II). All of the patients were followed postoperatively to determine and compare their functional outcomes related to donor site and recipient site complications, speech, deglutition and mouth opening. The speech intelligibility and deglutition were each assessed using Articulation Handicap Index and Vedio-fluoroscopy using the Functional oral intake scale. Operative time for STSG reconstruction was shorter at 2.2 ± 0.97 SD hours compared to 5.9 ± 1.24 SD hours for RAFFF reconstruction. Hospital stay was 8.3 ± 1.19 SD days for STSG patients and 12.6 ± 1.7 SD days for RAFFF patients. The functional outcomes of speech quality and swallowing were near comparable in both groups but the donor site complications were significant in the RAFFF group. Operative time, hospital stay and donor site complications are both significantly reduced with the STSG as opposed to RAFF. Functional and oncologic results of both methods are near comparable. To conclude, STSG can be used for reconstruction of the post-surgical defects in T2 lesions of the tongue.
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Affiliation(s)
| | - Gopika Kalsotra
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
| | - Parmod Kalsotra
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
| | - Aditiya Saraf
- grid.413224.20000 0004 1800 4333Department of ENT & HNS, GMC and SMGS Hospital, Jammu, J&K India
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Malinge M, Piot B, Longis J, Nham TT, Anquetil M, Bertin H. The sublingual gland flap: surgical technique and indications for the reconstruction of small oral defects. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2021. [DOI: 10.1051/mbcb/2021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liu J, Liu F, Fang Q, Feng J. Long-term donor site morbidity after radial forearm flap elevation for tongue reconstruction: Prospective observational study. Head Neck 2020; 43:467-472. [PMID: 33058368 DOI: 10.1002/hed.26506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess long-term donor site morbidity after radial forearm free (RFF) flap harvesting. METHODS Enrolled patients were asked to complete the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and undergo wrist motion and hand strength examinations at different time points. The data were prospectively collected and retrospectively analyzed. RESULTS The postoperative DASH score did not return to normal until 24 months after the operation. The mean postoperative wrist motion degree of flexion was significantly decreased compared to the preoperative level and returned to normal at 12 months after the operation. Similar trends were noted regarding extension, radial abduction, and ulnar abduction. The mean postoperative grip strength was significantly decreased compared to the preoperative level and remained dysfunctional at 24 months after the operation. A similar trend was also noted with regard to tip pinch and key pinch. CONCLUSION The long-term negative effect on hand strength is sustained.
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Affiliation(s)
- Jie Liu
- Department of Rehabilitation, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fei Liu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, China
| | - Juanjuan Feng
- Department of Rehabilitation, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Wei W, Qiu Y, Fang Q, Jia Y. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res 2018; 47:76-83. [PMID: 30514138 PMCID: PMC6384490 DOI: 10.1177/0300060518795530] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to compare the results of the pectoralis major myocutaneous (PMM) flap in primary and salvage head and neck cancer surgery. Methods A total of 160 patients were enrolled in this study. The salvage group consisted of 30 patients who received immediate PMM flap surgery following free flap failure. In the primary group, the PMM flap was primarily chosen for 130 patients. Related information was collected and analysed. The University of Washington (UW)-Quality of Life questionnaire, version 4, was mailed to every patient. Results Partial necrosis was significantly lower in the primary group (n = 13, 10.0%) than in the salvage group (n = 7, 23.3%). Surgical site infection was found in 10 (7.8%) patients in the primary group and in six (20.0%) patients in the salvage group. The mean composite quality of life scores were 66.8 ± 20.5 and 66.2 ± 22.1 in the two groups, respectively. Differences in scores for domains of activity, mood, and anxiety were significant. Disease-specific survival and recurrence-free survival rates were not different between the two groups. Conclusion PMM flap salvage reconstruction has a higher complication rate and poorer functional results, but similar survival prognosis, compared with primary surgery.
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Affiliation(s)
- Wei Wei
- 1 Department of Anesthesia, Children's Hospital Affiliated to Zhengzhou University, Henan provincial key laboratory of children's genetics and metabolic diseases Zhengzhou Children's Hospital, China
| | - Yongsheng Qiu
- 2 Department of Anesthesia, Affiliated Children's Hospital of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Qigen Fang
- 3 Department of Head and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yingping Jia
- 1 Department of Anesthesia, Children's Hospital Affiliated to Zhengzhou University, Henan provincial key laboratory of children's genetics and metabolic diseases Zhengzhou Children's Hospital, China
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Makiguchi T, Yokoo S, Ogawa M. Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure. Int J Oral Maxillofac Surg 2018; 47:1274-1280. [PMID: 29402515 DOI: 10.1016/j.ijom.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 11/27/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
Abstract
The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion. The morphology of the commissure with the mouth closed was classified based on the point of entrance of the vermilion into the oral cavity. In normal volunteers, the commissure pattern consisting of the entrance of the upper vermilion into the oral cavity before the lower vermilion and just prior to forming the oral commissure was considered to be the standard. However, in the reconstructed cases, there was an increase in the pattern in which the lower vermilion enters the oral cavity before the upper vermilion for the remaining commissure postoperatively, especially when the lower lip defects were greater than those of the upper lip. It is important to refer not only to the standard morphology of the commissure, but also to the changes according to the extent of resection and the method of reconstruction.
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Affiliation(s)
- T Makiguchi
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - S Yokoo
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - M Ogawa
- Department of Oral and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Liu F, Wang L, Pang S, Kan Q. Reconstruction of full-thickness buccal defects with folded radial forearm flaps: A retrospective clinical study. Medicine (Baltimore) 2017; 96:e7344. [PMID: 28796029 PMCID: PMC5556195 DOI: 10.1097/md.0000000000007344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our goal was to describe our experience of the folded radial forearm flap (RFF) flap in through-and-through buccal defect reconstructions.Patients who had received a folded RFF flap for full-thickness cheek defect reconstruction were included. The flap success rate and functional results were evaluated.Six patients were enrolled. All flaps survived totally without any complication; the mean flap size was 75.5 (range 32-135) cm. The mean mouth-open width was 4.2 (range 3.5-4.7) cm at 6 months after operation. All patients were satisfied with the appearance and were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling.Radial forearm flap was a reliable method for through-and-through buccal reconstruction with high success rate and good functional result.
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Affiliation(s)
- Fei Liu
- Department of Stomatology, the First Affiliated Hospital of zhengzhou University, Zhengzhou
| | - Lei Wang
- Department of Stomatology, School of Stomatology, Xinxiang Medical Collage, Xinxiang
| | - Shuang Pang
- Department of Stomatology, Nanyang Stomatology Hospital, Nanyang
| | - Quancheng Kan
- Department of Gastroenterology, the First Affiliated Hospital of zhengzhou University, Zhengzhou, PR China
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Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy. J Craniofac Surg 2016; 27:e172-5. [DOI: 10.1097/scs.0000000000002261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Li P, Fang QG, Luo RH, Zhao M, Liu ST, Du W, Qi J. Reconstruction of full-thickness buccal defects with submental island flap. J Craniofac Surg 2016; 26:e104-6. [PMID: 25759929 DOI: 10.1097/scs.0000000000001281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our goal was to introduce the application of submental island flap in reconstructing through-and-through cheek defects. From January 2009 to January 2013, 7 patients (5 men and 2 women) with full-thickness buccal defects due to tumor resection received submental flap reconstruction at the Affiliated Tumor Hospital of Zhengzhou University; surgical procedure and success rate as well as functional results were described. Distal partial necrosis occurred in 1 flap, but all flaps survived. All patients were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling; the appearance was reported to be good or acceptable in all cases, and the mean postoperative mouth-open width was 4.2 (range, 3.7-5.0) cm. One patient had a local recurrence in the follow-up. Therefore, submental island flap is a reliable procedure for through-and-through buccal defects in selected patients.
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Affiliation(s)
- Peng Li
- From the Department of Head Neck & Thyroid Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
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Ren ZH, Wu H, Tan H, Wang K, Gong Z, Zhang S, Liu J, Zhu Z. [Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2015; 33:281-285. [PMID: 26281258 PMCID: PMC7030103 DOI: 10.7518/hxkq.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/01/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects. METHODS Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed. RESULTS Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05). CONCLUSION Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.
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Ren ZH, Wu H, Tan H, Wang K, Gong Z, Zhang S, Liu J, Zhu Z. [Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2015; 33:281-5. [PMID: 26281258 PMCID: PMC7030103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/01/2015] [Indexed: 07/26/2024]
Abstract
OBJECTIVE To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects. METHODS Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed. RESULTS Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05). CONCLUSION Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.
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Li P, Fang Q, Luo R, Zhao M, Liu S, Du W, Qi J, Lou W. Infrahyoid Myocutaneous Flap Versus Radial Forearm Free Flap in Treating Patients with cT1-2 Tongue Carcinoma. J HARD TISSUE BIOL 2015. [DOI: 10.2485/jhtb.24.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Peng Li
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Ruihua Luo
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Ming Zhao
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Shantin Liu
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Jinxing Qi
- Department of Head Neck and Thyroid Surgery, The Affiliated Tumor Hospital of Zhengzhou University
| | - Weihua Lou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University
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15
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Jin S, He Y, Tian Z, Feng S, Zhang Y. Superficial circumflex iliac artery perforator flap aided by color Doppler sonography mapping for like-with-like buccal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:170-6. [PMID: 25488012 DOI: 10.1016/j.oooo.2014.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess an alternative method for buccal reconstruction using a superficial circumflex iliac artery perforator flap (SCIP) with preoperative color Doppler sonography mapping. STUDY DESIGN From January 2014 to June 2014, we enrolled six patients with buccal defects that occurred following cancer resection. Surgical procedures, superficial circumflex iliac artery perforator flap anatomy, and the outcomes are described. RESULTS The flap sizes measured 30 to 63 cm(2). The mean diameter of the superficial circumflex iliac artery was 0.6 mm and of the vein was 1.1 mm. The mean arterial pedicle length was 6.9 cm, and the venous pedicle length was 7.3 cm. The mean reduction of mouth-open width was 0.4 cm. No flap failure was evident, and a good aesthetic outcome was obtained in all cases. CONCLUSIONS The SCIP flap is a reliable and pliable flap with long vascular pedicles, hidden donor site morbidity, and perfect texture match for buccal defect reconstruction.
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Affiliation(s)
- Shufang Jin
- Department of Oromaxillofacial-Head and Neck Oncology, Faculty of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yue He
- Department of Oromaxillofacial-Head and Neck Oncology, Faculty of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Zhuowei Tian
- Department of Oromaxillofacial-Head and Neck Oncology, Faculty of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shaoqing Feng
- Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Zhang
- Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Abstract
Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.
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Safdar J, Liu FY, Moosa Y, Xu ZF, Li ZN, Sun CF. Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors. Pak J Med Sci 2014; 30:739-44. [PMID: 25097508 PMCID: PMC4121689 DOI: 10.12669/pjms.304.5177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/20/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. METHODS A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly. RESULTS The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting (5.58±1.96hrs) was shorter than platysma flap (6.2±1.4hrs). The majority of the flaps (88-93%) were taken successfully in both groups. Submental flap was associated with significantly higher patients' satisfaction regarding acceptable functional outcomes (p-value 0.027). The mean reduction in mouth opening was significantly smaller in platysma group (0.37 ±0.18cms) than the submental group (0.47±0.16). CONCLUSION This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm(2) with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes.
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Affiliation(s)
- Jawad Safdar
- Jawad Safdar, MD, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
| | - Fa-Yu Liu
- Fa-Yu Liu, MD, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
| | - Yousuf Moosa
- Yousuf Moosa, MD, Department of Periodontology, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
| | - Zhong-Fei Xu
- Zhong-fei Xu, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
| | - Zhen-Ning Li
- Zhen-ning Li, MS, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
| | - Chang-Fu Sun
- Chang-Fu Sun, MD, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning 110002, PR China
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18
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Ren ZH, Wu HJ, Wang K, Zhang S, Tan HY, Gong ZJ. Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects. J Craniomaxillofac Surg 2014; 42:1583-9. [PMID: 25246225 DOI: 10.1016/j.jcms.2014.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 02/28/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The anterolateral thigh myocutaneous flap is one of the most commonly used flaps in reconstructive procedures, but its application in oral and maxillofacial defects has not been fully determined. Herein, we summarize the application of 1212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and examine their benefits in maxillofacial reconstruction of these defects. METHODS Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Patient ages ranged from 6 to 82 years with a mean age of 51.2 years. There are 1015 flaps showing single lobe and 197 flaps showing a multi-island pedicle and one of which carries the iliac bone. The largest area among the single flaps was 28 × 12 cm(2), and the smallest was 3 × 2 cm(2). RESULTS Among the 1212 transferred flaps, 1176 survived and 36 showed necrosis, a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing (10.1%), localized paraesthesia (50.1%), and altered quadriceps force (11.0%). No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time (23-121 min; average 51 min) for anastomosis of one vein and one artery was significantly less than that for two veins and one artery (45-153 min, average 83 min; p = 0.0003), which indicates one vein anastomosis can significantly reduce the operating time. CONCLUSION The anterolateral thigh myocutaneous flaps can be easily obtained and can provide a good amount of muscle for filling dead space and fascia lata. These flaps can be prepared into a separate fat flap, multi-island fascia with iliac bone, and other composite pedicle flaps to meet the various requirements of oral and maxillofacial defects. The subcutaneous fat thickness of the anterolateral area can vary considerably and thus can be used to repair defects requiring different flap thickness. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China
| | - Hong Yu Tan
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China
| | - Zhao Jian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China
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Fang QG, Shi S, Li M, Zhang X, Liu FY, Sun CF. Free flap reconstruction versus non-free flap reconstruction in treating elderly patients with advanced oral cancer. J Oral Maxillofac Surg 2014; 72:1420-4. [PMID: 24613030 DOI: 10.1016/j.joms.2014.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/09/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Our goal was to evaluate whether elderly patients can benefit from free flaps. MATERIALS AND METHODS The clinical information from the included patients was reviewed, and these patients were asked to complete the University of Washington Quality of Life, version 4, questionnaire. Comparisons of the different scales between the 2 groups were performed. RESULTS The difference in the mouth-opening width before and after surgery did not differ significantly (P = .621) in the patients with and without free flap reconstruction. However, free flap placement tended to preserve the original mouth-opening width. No significant differences were found in recurrence-free survival or disease-specific survival between the 2 groups. The mean quality of life score of the 2 groups was 77.5 ± 10.4 and 72.1 ± 10.8. Significant differences were found in the chewing domain scores between the 2 groups (P = .039). Patients with free flap reconstruction tended to score better in the appearance and taste domains (P = .073 and P = .053, respectively); however, they required longer operative times, and longer postoperative hospital stays and incurred hospital costs. CONCLUSIONS Free flap reconstruction did not benefit elderly patients in mouth-opening width or survival analyses; the only quality of life domain that was significantly improved in patients undergoing free flap reconstruction was chewing. Free tissue transfer should be cautiously suggested for elderly patients with advanced oral cancer.
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Affiliation(s)
- Qi-Gen Fang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Shuang Shi
- Resident, Department of Pediatric Dentistry, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Mengjie Li
- Resident, Department of Endodontic Dentistry, Jilin University School of Stomatology, Dongchang District, Changchun, Jilin, People's Republic of China
| | - Xu Zhang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Fa-Yu Liu
- Professor, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
| | - Chang-Fu Sun
- Professor, Department Head, Department of Oromaxillofacial-Head and Neck Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China.
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Fang QG, Shi S, Zhang X, Li ZN, Liu FY, Sun CF. Assessment of the quality of life of patients with oral cancer after pectoralis major myocutaneous flap reconstruction with a focus on speech. J Oral Maxillofac Surg 2013; 71:2004.e1-2004.e5. [PMID: 24135522 DOI: 10.1016/j.joms.2013.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/02/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the quality of life (QoL) of patients with oral cancer who had undergone resection of the tongue and floor of the mouth and reconstruction with the pectoralis major flap. MATERIALS AND METHODS The present study assessed 21 patients who had undergone pectoralis major flap reconstruction using the University of Washington QoL, version 4, questionnaire. A nonparametric Mann-Whitney U test was used to analyze the data. RESULTS Of the 12 disease-specific domains, the best 3 scores from the patients were for pain, saliva, and anxiety, and the worst 3 scores were for taste, chewing, and swallowing. The mean UW-QoL composite score was 73.4. Swallowing was considered to be the most important issue within the previous 7 days, followed by chewing and speech. Those patients who had undergone wider excision had poorer speech. CONCLUSIONS A significant effect was found on the QoL of patients with oral cancer who had undergone resection of the tongue and floor of the mouth with pectoralis major flap reconstruction.
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Affiliation(s)
- Qi-Gen Fang
- Resident, Department of Oromaxillofacial-Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology, Heping District, Shenyang, Liaoning, People's Republic of China
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21
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Fang QG, Shi S, Zhang X, Li ZN, Liu FY, Sun CF. Upper extremity morbidity after radial forearm flap harvest: a prospective study. J Int Med Res 2013; 42:231-5. [DOI: 10.1177/0300060513508041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the effect of radial forearm free (RFF) flap harvest on patient-reported postoperative upper extremity disability. Methods Patients undergoing RFF flap reconstruction following resection of head and neck cancer were recruited and matched with similar patients undergoing non-RFF reconstruction. All subjects completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and at least 1 year postoperatively. Results Postoperative DASH scores were significantly higher (more severe disability) in patients undergoing RFF flap reconstruction (6.93 ± 5.54; n = 52) compared with those undergoing non-RFF flap surgeries (2.95 ± 4.42; n = 52). Preoperative DASH score, flap size, patient age and tumour stage were significantly correlated with postoperative DASH score. Conclusion Excluding the effect of neck dissection, RFF flap reconstruction has a significant deleterious effect on upper extremity function.
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Affiliation(s)
- Qi-Gen Fang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
| | - Shuang Shi
- Department of Paediatric Dentistry, School of Stomatology, China Medical University, Liaoning, China
| | - Xu Zhang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
| | - Zhen-Ning Li
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
| | - Fa-Yu Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
| | - Chang-Fu Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
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