The main objective of reconstructions with flaps at the height of the oral cavity is to promote fast functional recovery (to carry out functions like mastication, swallowing and phonation), which is a difficult aim to accomplish seeing as the anatomy of the oral cavity makes it difficult to achieve an exact tridimensional reconstruction. Furthermore, the microsurgery employed must follow the movements of the residual muscle structure and must, therefore, be modelled with extreme precision. Consequently, the choice of the most suitable reconstructive treatment is considered the key to successful therapy. The authors relay their experience between 1991 and 2004, consisting of 174 patients treated surgically for a neoplasia of the oral cavity which was advanced locally and which was later reconstructed with a free flap. The free flaps therefore represent the gold standard to be obtained in reconstructions of the oral cavity. We would like to point out, among the numerous advantages, the possibility of modelling to suit without the obligation to use an awkward vascular pedicle and nonetheless obtaining a faithful anatomical reconstruction of the original structures. The prevalence in the use of different flaps for the reconstruction of the soft parts has changed radically with the introduction of perforator flaps. The flap which we apply most frequently at present is ALT (53 cases) which can be easily modelled and thinned. The other flaps used in the period concerned are: radial forearm flap (40 cases), TRAM (25 cases), lateral arm flap (10 cases), latissimus dorsi flap (4 cases), and DIEP (3 cases). For patients requiring mandibular bone reconstruction as well, we used mainly fibula flaps (26 cases) and the iliac crest (13 cases). Furthermore, the number of flap complications was less than that of the local flaps, above all if the reconstruction was carried out on tissues which were irradiated previously. Complications in fact were relatively rare and were, in any case, resolved within a short space of time
Developmental trend in microsurgical reconstruction after neoplasia of the oral cavity
Bianchi, A.;
2004-01-01
Abstract
The main objective of reconstructions with flaps at the height of the oral cavity is to promote fast functional recovery (to carry out functions like mastication, swallowing and phonation), which is a difficult aim to accomplish seeing as the anatomy of the oral cavity makes it difficult to achieve an exact tridimensional reconstruction. Furthermore, the microsurgery employed must follow the movements of the residual muscle structure and must, therefore, be modelled with extreme precision. Consequently, the choice of the most suitable reconstructive treatment is considered the key to successful therapy. The authors relay their experience between 1991 and 2004, consisting of 174 patients treated surgically for a neoplasia of the oral cavity which was advanced locally and which was later reconstructed with a free flap. The free flaps therefore represent the gold standard to be obtained in reconstructions of the oral cavity. We would like to point out, among the numerous advantages, the possibility of modelling to suit without the obligation to use an awkward vascular pedicle and nonetheless obtaining a faithful anatomical reconstruction of the original structures. The prevalence in the use of different flaps for the reconstruction of the soft parts has changed radically with the introduction of perforator flaps. The flap which we apply most frequently at present is ALT (53 cases) which can be easily modelled and thinned. The other flaps used in the period concerned are: radial forearm flap (40 cases), TRAM (25 cases), lateral arm flap (10 cases), latissimus dorsi flap (4 cases), and DIEP (3 cases). For patients requiring mandibular bone reconstruction as well, we used mainly fibula flaps (26 cases) and the iliac crest (13 cases). Furthermore, the number of flap complications was less than that of the local flaps, above all if the reconstruction was carried out on tissues which were irradiated previously. Complications in fact were relatively rare and were, in any case, resolved within a short space of timeI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
