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Retromolar Trigone Reconstructive Surgery: Prospective Comparative Analysis Between Free Flaps

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Retromolar trigone (RMT) tumours are rare and aggressive malignancies, which require an aggressive surgical approach. The reconstruction oral cavity defects represent a challenge because of the critical role of this area both aesthetically and functionally. Free radial forearm (RF) or anterolateral thigh (ALT) flap are the first choice for the repair of intraoral defects. In reviewing the literature, there is lack of evidence pertaining to the differences between RF and ALT flaps in the reconstruction of patients with RMT tumours. This study evaluates the better microvascular reconstruction after RMT cancer resection.

Methods

Thirty patients with RMT cancer underwent oropharingectomy and microvascular reconstruction using the free RF flap (RF group) and the ALT perforator flap (ALT group). The two groups were homogeneous for sex, age, anatomic area, body mass index, and clinicopathologic profile. Viability, complications, scarring, cosmetic appearance, disorder of sensations, ROM, disease-specific items and satisfaction rate were analyzed, and statistical analysis was performed.

Study Design

Prospective study.

Results

There were differences between the RF and ALT groups in the morphofunctional outcomes, both short-term and long-term follow-up. These differences were statistically significant (p < 0.05) for donor site complications, cosmetic appearance, and scar evaluations. Manual dexterity was slower on the operated donor side than on the nonoperated side in the 33.3 % in the RF group.

Conclusions

The study showed that the free ALT perforator flap provides better results in appearance and scarring than the RF flap for intraoral reconstruction after RMT cancer resection.

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References

  1. Deo SV, Shukla NK, Kallianpur AA, et al. Aggressive multimodality management of locally advanced retromolar trigone tumors. Head Neck. 2013;35:1269–73.

    Article  PubMed  Google Scholar 

  2. Hao SP, Tsang NM, Chang KP, et al. Treatment of squamous cell carcinoma of the retromolar trigone. Laryngoscope. 2006;116:916–20.

    Article  PubMed  Google Scholar 

  3. Li W, Xu Z, Liu F, et al. Vascularized free forearm flap versus free anterolateral thigh perforator flaps for reconstruction in patients with head and neck cancer: assessment of quality of life. Head Neck. 2013;35:1808–13.

    Article  PubMed  Google Scholar 

  4. Cöloğlu H, Coşkun E, Uysal AC, et al. Anterior superficial temporal artery island flap: intraoral defect repair. J Craniofac Surg. 2012;23:e594–9.

    Article  PubMed  Google Scholar 

  5. Welkoborsky HJ, Deichmüller C, Bauer L, et al. Reconstruction of large pharyngeal defects with microvascular free flaps and myocutaneous pedicled flaps. Curr Opin Otolaryngol Head Neck Surg. 2013;21:318–27.

    PubMed  Google Scholar 

  6. Wong CH, Lin JY, Wei FC. The bottom-up approach to the suprafascial harvest of the radial forearm flap. Am J Surg. 2008;196:e60–4.

    Article  PubMed  Google Scholar 

  7. Rigby MH, Taylor SM. Soft tissue reconstruction of the oral cavity: a review of current options. Curr Opin Otolaryngol Head Neck Surg. 2013;21:311–7.

    Article  PubMed  Google Scholar 

  8. Putten L, Spasiano R, Bree R, et al. Flap reconstruction of the hypopharynx: a defect orientated approach. Acta Otorhinolaryngol Ital. 2012;32:288–96.

    PubMed Central  PubMed  Google Scholar 

  9. Mura F, Bertino G, Occhini A, et al. Advanced carcinoma of the hypopharynx: functional results after circumferential pharyngolaryngectomy with flap reconstruction. Acta Otorhinolaryngol Ital. 2012;32:154–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  10. Colletti G, Autelitano L, Tewfik K, et al. Autonomized flaps in secondary head and neck reconstructions. Acta Otorhinolaryngol Ital. 2012;32:329–35.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Montemari G, Rocco A, Galla S, et al. Hypopharynx reconstruction with pectoralis major myofascial flap: our experience in 45 cases. Acta Otorhinolaryngol Ital. 2012;32:93–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg. 1986;78:1–8.

    Article  CAS  PubMed  Google Scholar 

  13. Haerle M, Hafner HM, Dietz K, et al. Vascular dominance in the forearm. Plast Reconstr Surg. 2003;111:1891–8.

    Article  PubMed  Google Scholar 

  14. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flap. Plast Reconstr Surg. 2002;109:2219–26.

    Article  PubMed  Google Scholar 

  15. Chen HC, Tang YB. Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg. 2003;30:383–401.

    Article  PubMed  Google Scholar 

  16. Wu CC, Lin PY, Chew KY, et al. Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery. 2013;34:339–344.

  17. George RK, Krishnamurthy A. Microsurgical free flaps: controversies in maxillofacial reconstruction. Ann Maxillofac Surg. 2013;3:72–9.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Chen CM, Lin GT, Fu YC, et al. Complications of free radial forearm flap transfers for head and neck Reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:671–6.

    Article  PubMed  Google Scholar 

  19. Rhemrev R, Rakhorst HA, Zuidam JM, et al. Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections. J Plast Reconstr Aesthet Surg. 2007;60:588–92.

    Article  CAS  PubMed  Google Scholar 

  20. Song YG, Chen GZ, Song YL. The free thigh flap: A new free flap concept based on the septocutaneous artery. Br J Hast Surg. 1984;37:149–59.

    Article  CAS  Google Scholar 

  21. Demirkan F, Chen HC, Wei FC, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg. 2000;53:30–36.

    Article  CAS  PubMed  Google Scholar 

  22. Lueg EA. The anterolateral thigh flap: Radial forearm’s “big brother” for extensive soft tissue head and neck defects. Arch Otolaryngol Head Neck Surg. 2004;130:813–8.

    Article  PubMed  Google Scholar 

  23. Tarsitano A, Vietti MV, Cipriani R, et al. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap. Acta Otorhinolaryngol Ital. 2013;33:374–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  24. Ozkan O, Mardini S, Chen HC, et al. Repair of buccal defects with anterolateral thigh flaps. Microsurgery. 2006;26:182–9.

    Article  PubMed  Google Scholar 

  25. Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg. 2014;133:420–9.

    Article  CAS  PubMed  Google Scholar 

  26. Sun GW, Lu MX, Wu WM, et al. Clinical application of free thin anterolateral thigh flap in the reconstruction of intraoral defects. Zhonghua Zheng Xing Wai Ke Za Zhi. 2013;29:321–4.

    PubMed  Google Scholar 

  27. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg. 2014;72:246–52.

    Article  CAS  PubMed  Google Scholar 

  28. Sardesai MG, Fung K, Yoo JH, et al. Donor-site morbidity following radial forearm free tissue transfer in head and neck surgery. J Otolaryngol Head Neck Surg. 2008;37:411–6.

    PubMed  Google Scholar 

  29. Nehrer-Tairych GV, Millesi W, Schuhfried O, et al. A comparison of the donor-site morbidity after using the prelaminated fasciomucosal and the fasciocutaneous radial forearm flap for intraoral reconstruction. Br J Plast Surg. 2002;43:198–202.

    Article  Google Scholar 

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Disclosure

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Author information

Authors and Affiliations

  1. Plastic Reconstructive Surgery Unit, La Sapienza University of Rome, Rome, Italy

    Emanuele Cigna MD, PhD, Michele Maruccia MD, Diego Ribuffo MD & Nicolò Scuderi MD

  2. Advanced Technology in Surgery, Department of Surgical Science, La Sapienza University, Rome, Italy

    Maria Ida Rizzo MD

  3. Otorhinolaryngology Unit, La Sapienza University of Rome, Rome, Italy

    Antonio Greco MD, Armando De Virgilio MD & Marco De Vincentiis MD

  4. Department of M.I.P.I. Diseases, National Institute of Health, Rome, Italy

    Annapina Palmieri MD

Authors
  1. Emanuele Cigna MD, PhD
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  2. Maria Ida Rizzo MD
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  3. Antonio Greco MD
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  4. Armando De Virgilio MD
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  5. Annapina Palmieri MD
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  6. Michele Maruccia MD
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  7. Diego Ribuffo MD
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  8. Nicolò Scuderi MD
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  9. Marco De Vincentiis MD
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Corresponding author

Correspondence to Maria Ida Rizzo MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2014_3963_MOESM1_ESM.tiff

Patient reconstructed using RF flap: (A) Design; (B) Oral reconstruction; (C) Donor site.Supplementary material 1 (TIFF 15908 kb)

10434_2014_3963_MOESM2_ESM.tiff

Patient reconstructed using ALT flap: (A) Design; (B) Oral reconstruction; (C) Donor site. Supplementary material 2 (TIFF 10219 kb)

Supplementary material 3 (DOCX 45 kb)

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Cigna, E., Rizzo, M.I., Greco, A. et al. Retromolar Trigone Reconstructive Surgery: Prospective Comparative Analysis Between Free Flaps. Ann Surg Oncol 22, 272–278 (2015). https://doi.org/10.1245/s10434-014-3963-4

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  • DOI: https://doi.org/10.1245/s10434-014-3963-4

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