Reconstruction for Various Subtypes of Unilateral Buccal Defects After Oncologic Surgery by Using Personalized Anterolateral Thigh Flaps

Abstract

Purpose: Radical resection of buccal carcinoma frequently leads to intraoral or through-and-through buccal defects. Anterolateral thigh (ALT) flaps can be harvested to reconstruct different buccal defect subtypes. The purpose of this study was to investigate clinical outcomes after the application of personalized ALT flaps for the precise reconstruction of unilateral buccal defects.

Materials and methods: Patients with primary unilateral buccal carcinoma who underwent tumor ablation and simultaneous reconstruction of personalized ALT flaps from January 2015 to January 2018 were enrolled in this retrospective case series. Buccal defects were classified into 4 subtypes. Demographic features, defect range and reconstructive method, and perioperative characteristics were reviewed and recorded. Quality of life and mouth opening were assessed by the University of Washington Quality-of-Life questionnaire and interincisal distance (IID), respectively, during follow-up. Descriptive statistics were calculated for each study variable.

Results: Four types of ALT flaps were harvested and used to reconstruct different buccal defects in 146 patients. Of the 193 skin paddles applied, 189 survived, and few recipient- and donor-site complications were observed. One hundred eight patients were assessed with the University of Washington Quality-of-Life questionnaire and followed until 12 months postoperatively. Our results showed that physical, functional, social, and emotional domain scores increased steadily during the follow-up period. Ninety-eight patients showed improvements in mouth opening when the IID before the operation was compared with the IID at 3 and 6 months postoperatively.

Conclusions: A personalized ALT flap is a suitable choice for reconstructing unilateral buccal defects after oncologic surgery given its high success rate, customizable and flexible design, low complication rate, and satisfactory esthetic and functional results.