Application of chimerical ALT perforator flap with vastus lateralis muscle mass in the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective clinical study

Background: Patients with tongue carcinoma who undergo combined tongue and neck radical resection often have the oral and submandibular defects simultaneously. Because of the high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by the surgeons for the oral reconstruction. However, the tissue volume of a perforator flap is insufficient for the reconstruction of both oral and submandibular regions. In this retrospective study, we compared the postoperative effects and complications between two groups of patients. One group was reconstructed with the classical ALT perforator flap and the other was reconstructed with the chimeric ALT perforator flap with a mass of vastus lateralis muscle. Methods: From Aug 2017 to Aug 2019, 25 patients were reconstructed with classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between two groups. Results: There were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4％ and 40％ in the chimeric and classical group, respectively. The duration of recovery was 12.20±2.69 and 15.67±4.09 days in the chimeric and classical group, respectively. The submandibular region was fullness and satisfactory in chimeric group. The postoperative life quality in the chimeric group was better than that in the classical group ( P ＜0.05). Conclusions: The chimerical ALT perforator flap with muscle mass can reconstruct the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and reduces the incidence of submandibular infection.