A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept
| Autor: | Daniel P. Butler, FRCS (Plast), Jonathan A. Dunne, FRCS (Plast), Simon H. Wood, FRCS (Plast), Navid Jallali, MB ChB (Hons), MD, FRCS (Plast) |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Plastic and Reconstructive Surgery, Global Open, Vol 7, Iss 7, p e2267 (2019) |
| Druh dokumentu: | article |
| ISSN: | 2169-7574 00000000 |
| DOI: | 10.1097/GOX.0000000000002267 |
| Popis: | Background:. Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population. Methods:. All intraoral defects requiring microvascular reconstruction from February 2012 to August 2018 were reviewed. Defects were classified according to their depth as unilaminar (type U = mucosa only), bilaminar (type B = mucosa and bone), or trilaminar (type T = mucosa, bone, and skin) and the number and side of mucosal zones involved (from 1 to 5). Hard palate defects were considered separately and excluded if part of a wider maxillectomy defect. Results:. A total of 118 patients were eligible for inclusion in the study. Of type U defects involving 1 mucosal zone, 98% were reconstructed with a radial forearm free flap. Ninety-two percentage of type U defects involving ≥2 mucosal zones were reconstructed with an anterolateral thigh flap. Among type B defects, 86% were reconstructed with a fibula osseocutaneous free flap if less than 4 mucosal zones were involved and 100% reconstructed with an ALT if ≥4 mucosal zones were involved. The algorithm presented was accurate for 93% of the cases. Ninety-eight percentage of patients achieved intelligible speech and 72% returned to a normal diet. Flap success rate was 100%. Conclusions:. The algorithm presented provides a simple system to guide the reconstruction of oral cavity defects. |
| Databáze: | Directory of Open Access Journals |
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