[Application of various flaps to intraoral reconstruction of buccal defects after resection of buccal mucosa carcinoma]

Abstract

Background and objective: Reconstructing buccal defects with proper flaps can expand the indications of surgery, improve quality of life and prolong survival. This study was to investigate the indications for such application, the selection of different kinds of flaps and the skills of the reconstructive operation.

Methods: From September 2005 to August 2007, 26 patients underwent reconstructive operation after resection of buccal mucosa carcinoma: eight had simple buccal mucosa resection, 11 had resection of the bucca cavioris and facial skin, seven had resection of the bucca cavioris, facial skin and angulus oris; besides, seven patients underwent parotid duct resection. As for the reconstructive operation, pectoralis major myocutaneous flap was used in five patients, free radial forearm flap in 11 patients, free anterolateral thigh flap in six patients, and sternodeiceomastoid myocutaneous flap in four patients. Eight patients received postoperative radiotherapy at 66-70 Gy.

Results: No perioperative death occurred. Necrosis happened in one patient who used free radial forearm flap; partial necrosis in one patient who used pectoralis major myocutaneous flap. The survival rate of the flaps was 96.2%. Hydrops of the operative wound happened in one patient with salivary fistula. During the follow-up of 1-3 years, seven patients had recurrence (four had recurrence in primary lesion and three in cervical lymph nodes), two died of recurrence in primary lesion.

Conclusion: The free anterolateral thigh flap and free radial forearm flap are suitable for reconstruction of large buccal defects, and are first-choices for defects larger than 4 cm; the pectoralis major myocutaneous flap can be applied as the second-choice flap; the sternodeiceomastoid myocutaneous flap can be used for defects smaller than 4 cm.