3D modeling of anterior 2/3rds glossectomy reconstruction: A volume based donor site evaluation.

Autor: Smith B; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA., Rosko A; Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA., VanKoevering KK; Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Heft Neal M; Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA., Ellsperman S; Department of Otolaryngology - Head and Neck Surgery, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA., Fenberg RB; Albert Einstein College of Medicine, Bronx, NY, USA., Cho J; Kresge Hearing Research Institute, University of Michigan, USA., Vita A; Department of Internal Medicine, University of Michigan, USA., Feng AL; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA., Contrera KJ; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA., Sridharan SS; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA., Spector ME; Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA. Electronic address: spectome@upmc.edu.
Jazyk: angličtina
Zdroj: Oral oncology [Oral Oncol] 2024 Oct; Vol. 157, pp. 106960. Date of Electronic Publication: 2024 Jul 27.
DOI: 10.1016/j.oraloncology.2024.106960
Abstrakt: Objective: Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection.
Methods: Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI.
Results: In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm 3 . Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm 3 ), followed by latissimus (105.6 cm 3 ), parascapula (97.8 cm 3 ), and ALT (60.5 cm 3 ). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume).
Conclusion: The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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