Clinical application of free anterolateral thigh flap in oral and maxillofacial surgery

Abstract:

Objective：To investigate the clinical features and efficacy of vascularized free anterolateral thigh flap（ALTF） for repair of tissue defects in oral and maxillofacial surgery. Methods：Totally 39 patients with maxillofacial defects due to different causes in our department between January 2011 and February 2013 were enrolled in our study including 36 cases caused by extended resection of oral and maxillofacial carcinoma，one case caused by resection of facial giant neurofibroma and 3 cases of maxillofacial soft tissue de－fect by injury. During the surgery，flaps at a size equivalent to recipient area were cut and some flaps with muscle sleeves were used to fill the dead spaces；the descending branch of the femoral artery was end-to-end anastomosed with external maxillary artery and the accompanying vein of the vascular pedicle was end-to-side anastomosed with the internal jugular vein or external jugular vein. The survival of the flap graft and the characteristics of the functional reconstruction of the recipient area were recorded. Results：Of the 39 cases，36 showed survival of skin flaps. One patient with diabetes mellitus presented with venous vascular crisis at 15 h after the surgery and then experienced total necrosis of skin flaps in spite of the active rescue. Two patients presented with venous vascular crisis at 10-15 h after the surgery and survived completely after the rescue. The patients were followed-up for 6-30 months（mean 9.7 months）. There was no shrinkage of the surface area of the flaps in the recipient area. 1/3-1/2 of the subcutaneous adipose tissues were absorbed. Linear scar tissue formed in the donor area yet without no significant deformity and the legs had normal activity. Conclusion：Vascu－larized free ALTF is characterized by advantages of simple operation，easy to learn，plastic，satisfactory in shape and function of the recipient area，rich in tissue dose in the donor area，constant in the location of blood vessels，long in vascular pedicle length and little impact on the appearance and function of the donor area. Thus it can be widely applied in the tissue defect reconstruction in oral and maxillofacial surgery.