Effect of Anterolateral Thigh Perforator Flap Repair on the Appearance, Language and Masticatory Function of Oral Cancer Patients after Radical Surgery

Purpose: The purpose was to explore the application effect of anterolateral thigh perforator flap (ALTP) and pectoralis major myocutaneous flap on repairing the tissuedefects after oral cancer surgery. Methods: 100 oral cancer patients treated in our hospital from January 2018 to December 2020 were selected as the research objects. After both groups of patients received extended resection of tumors, neck lymph node dissection and other routine treatment, the control group was repaired by pectoralis major myocutaneous flap while the study group was repaired by ALTP to compare the flap survival rate, language, masticatory function and other related indicators between the two groups. Results: The flap harvesting time and defect repair time in the control group were shorter than those in the study group (P<0.05); The language, masticatory function and swallowing function in both groups after treatment were significantly better than those before treatment (P<0.05); The total incidence of complications in the study group was significantly lower than that in the control group (P<0.05); After treatment, the quality of life scores in both groups were significantly higher than those before treatment (P<0.05). Conclusion: Both ALTP and pectoralis major myocutaneous flap can be used to repair the tissue defects after radical resection of oral cancer, which can effective improve the postoperative appearance, language and masticatory function of oral cancer patients. However, pectoralis major myocutaneous flap has easier operation and shorter operation time while ALTP can significantly reduce the incidence of postoperative complications with higher safety.

POST-SURGICAL SHOULDER REHABILITATION OF SELECTIVE NECK DISSECTION WITH PECTORALIS MAJOR MYOCUTANEOUS FLAP RECONSTRUCTION IN “SICK” SYNDROME PATIENTS

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.

Alternatives to free flap surgery for maxillofacial reconstruction: focus on the submental island flap and the pectoralis major myocutaneous flap

Background Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF). Methods This retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics. Results 24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group. Conclusions The pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction.