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Guo K, Li M, Qi J, Han S, Wu X, Guo F. Precise maxillofacial soft tissue reconstruction: A combination of cone beam computed tomography and 3dMD photogrammetry system. Heliyon 2024; 10:e32513. [PMID: 38994088 PMCID: PMC11237927 DOI: 10.1016/j.heliyon.2024.e32513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/02/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction The reconstruction of both extra- and intra-oral soft tissue defects, particularly in restoring the morphology of the lip and the corners of the mouth, has posed a significant challenge for surgeons. Inappropriate methods often lead to maxillofacial deformity which then causes psychological and functional problems. This study aimed to address the challenge of reconstructing extensive and complex maxillofacial soft tissue defects, mainly focusing on the lip, the corners of the mouth, and the surrounding areas. Materials and methods We developed a reconstruction approach by combining the 3dMDface System (3dMD) with the cone beam computed tomography (CBCT). Firstly, with the extra-oral incision line, we evaluated the shape and the size of the extra-oral defect with 3dMD digitally. Then we used the corresponding maxillary and mandible tooth positions to record the intra-oral defect, which was then converted to digital images by combining 3dMD and CBCT. The islands of the anterolateral thigh perforator flap were then designed after the locations of the perforators were detected with Doppler ultrasonography. Results A clinical case diagnosed as dermatofibrosarcoma protuberans was presented to illustrate the approach. The patient's tumor resection and the size of multiple defects were measured and simulated via the virtual surgery system. A three-island perforator flap from the descending branch of the lateral femoral circumflex artery was designed accurately. Two weeks postoperatively, the flap was healed as anticipated and the patient was satisfied with the profile. Conclusion The combination of the 3dMD and CBCT technologies improves the accuracy and fitness of extra- and intra-oral soft tissue reconstruction.
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Affiliation(s)
- Kaizhao Guo
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Stomatology, Strategic Support Force Medical Center, Beijing, China
- Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China
- Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Min Li
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China
- Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Jiewen Qi
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China
- Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Shengyang Han
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China
- Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoshan Wu
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- Academician Workstation for Oral-Maxillofacial Regenerative Medicine, Central South University, Changsha, China
- Research Center of Oral and Maxillofacial Development and Regeneration, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Guo
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
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Lee YJ, Kim J, Lee CR, Kim JH, Oh DY, Jun YJ, Moon SH. Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects. J Clin Med 2023; 12:6723. [PMID: 37959189 PMCID: PMC10648588 DOI: 10.3390/jcm12216723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The anterolateral thigh (ALT) skin flap provides abundant, thin, pliable skin coverage with adequate pedicle length and calibre, and tolerable donor site morbidity. However, coverage of relatively large defects using the ALT flap alone is limited. We present our experience of using the ALT flap coupled with the vastus lateralis (VL) flap supplied by the same pedicle for large defect reconstruction. Between 2016 and 2020, ten patients with extensive lower-extremity or trunk defects were treated using the ALT/VL chimeric flap. The ALT portion was used to cover the cutaneous and joint defect while the VL part was used to resurface remnant defects, and a skin graft was performed. All flaps were based on the common descending pedicle, and branches to separate the components were individually dissected. All defects were successfully reconstructed using the ALT/VL chimeric flap. No surgery-related acute complications were observed, and the patients had no clinical issues with ambulation or running activities during the long-term follow-up period. With the separate components supplied by a common vascular pedicle, the ALT/VL chimeric flap allows us to reconstruct extensive defects with joint involvement or posterior trunk lesions. Thus, the ALT/VL chimeric flap may be a suitable alternative for extensive tissue defect reconstruction.
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Affiliation(s)
- Yoon Jae Lee
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea; (Y.J.L.); (J.H.K.)
| | - Junnyeon Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Chae Rim Lee
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Jun Hyeok Kim
- Department of Plastic and Reconstructive Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea; (Y.J.L.); (J.H.K.)
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Young Joon Jun
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.K.); (C.R.L.); (D.Y.O.); (Y.J.J.)
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Matsui C, Escandón JM, Mohammad A, Tanaka T, Wynn ET, Mizuno H, Roche N. Clinical applications of the chimeric anterolateral thigh (ALT) flap in head and neck reconstruction. Acta Chir Belg 2023; 123:473-480. [PMID: 35499297 DOI: 10.1080/00015458.2022.2073016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a common complication following head and neck surgery. Dead space at the excision site can increase the risk of infection, abscess formation, and mortality. Herein, we evaluated the performance of the chimeric anterolateral thigh (ALT) flap in addressing these concerns. METHODS Patients who underwent oncologic head and neck reconstruction between October 2016 and November 2021 were divided in two groups: a normal ALT flap and a chimeric dead space filling (DSF) ALT-vastus lateralis flap group. We evaluated the postoperative outcomes. RESULTS Twenty-five patients treated with normal ALT flaps (34.7%) and 47 with DSF ALT flap group (65.2%) were included. Only one ALT per case was necessary. Most of the cases involved tongue (31.9%) and lower gingival reconstruction (27.8%). The time to harvest the DSF ALT flap was 134.3 min when compared to the normal ALT flap (116.2 min, p < .001). Vascular occlusion, flap loss, partial necrosis, and fat necrosis were not observed among the different groups. CONCLUSION The DSF process can be used as a preventive measure for SSI or vessel exposure due to radiation-induced skin damage. This flap allows same-site reconstruction if the primary tumor recurs by using the pedicle of the chimeric flap for reattachment of another free flap.
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Affiliation(s)
- Chihiro Matsui
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Strong Memorial Hospital, New York, NY, USA
| | - Arbab Mohammad
- Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | | | - Ei Thinzar Wynn
- Department of Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
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Shetty D, Kumar N, Desai AK, Anehosur V. Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience. J Cancer Res Ther 2023; 19:1255-1260. [PMID: 37787292 DOI: 10.4103/jcrt.jcrt_1761_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.
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Affiliation(s)
- Deepthi Shetty
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Niranjan Kumar
- Department of Plastic and Reconstructive Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Anil Kumar Desai
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
| | - Venkatesh Anehosur
- Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Sattur, Dharwad, Karnataka, India
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Zhao J, Zeng W, Li K, Huang J, Tong MCF, Deng L, Zhang X. Repair of postoperative defects of oral cancer with submental island flaps based on vascular pedicles of different states: a multicenter retrospective study. Sci Rep 2022; 12:21257. [PMID: 36481648 PMCID: PMC9731967 DOI: 10.1038/s41598-022-24293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Submental island flap has certain advantages in repairing postoperative defects of oral cancer, and it can often achieve similar or even better effects compared with those of the free tissue flap. In this study, according to the different characteristics of patients and postoperative defects of oral cancer, submental island flaps with different states of vascular pedicle were prepared, and its repair methods, safety, and clinical effects in treating postoperative defects of oral cancer were investigated. 83 patients with oral cancer who met the inclusion criteria were selected. According to the different characteristics of the patients and postoperative defects of oral cancer, the traditional submental island flap vascular pedicle was modified into three different states: submental artery perforator flap, vascular pedicled flap with the anterior belly of digastric muscle but without the submandibular gland (SIF with anterior belly of DM), and vascular pedicled flap with the anterior belly of the digastric muscle and the submandibular gland (SIF with anterior belly of DM and SG). The types of the submental artery and the drainage vein, flap survival, and complications, were observed. The flap was successfully harvested for all patients, and the submental artery could be found or separated for all of them, with the venous drainage to the internal jugular vein in 57 (57/83, 68.67%), to the external jugular vein in 18 (18/83, 21.69%), and to the anterior jugular vein in eight (8/83, 9.64%) cases. Submental artery perforator flap was used for 11 cases, complete necrosis occurred in two cases (2/11, 18.18%), partial necrosis occurred in one case (1/11, 9.09%); SIF with anterior belly of DM was used for 49 cases, complete necrosis occurred in one case (1/49, 2.04%), partial necrosis occurred in four cases (4/49, 8.16%); SIF with anterior belly of DM and SG was used for 23 cases, including chimeric flap combining the submental island flap and the submandibular gland used for 15 cases, there were no cases of complete or partial necrosis. Submental island flap was effective in repairing postoperative defects of oral cancer. Submental island flaps with three different states of vascular pedicle could repair oral cancer-affected tissues with different defect characteristics.
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Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR People’s Republic of China
| | - Lifei Deng
- Department of Head and Neck, Jiang Xi Caner Hospital, No. 519, Beijing East Road, Nanchang, Jiangxi People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital, Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, No. 3004, Longgang Avenue, Shenzhen, Guangdong People’s Republic of China
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