Turned in fasciocutaneous island flap from face and neck based on subdermal microcirculation for reconstruction of the oral cavity following cancer surgery

ABSTRACT

Background: The skin and soft tissues of the face and neck have a rich plexus of dermal-subdermal vessels, which creates the possibility of raising a fasciocutaneous flap based on this vascular supply. A turned in fasciocutaneous island flap (TIFCIF) from an adjacent area of the defect can provide a simple substitute to many complex reconstructive procedures. Materials and Methods: Fifteen patients underwent wide excision for oral cancer and upper neck dissection, maintaining bone framework, between August 2010 and June 2014. The reconstruction was done with a 'turned in fasciocutaneous island flap’ (TIFCIF) from the upper neck-lower face based on subdermal superficial adipofascial microvascular network instead of a specific known feeder vessel. The upper cervical flap, the donor site, when raised during the initial incision and the upper neck dissection, was cut off from the facial artery, the submental artery, the superior thyroid and the transverse cervical arteries. The microcirculation depended largely on the rich vascular plexus formed of the branches of the superficial temporal and the maxillary arteries. The donor site was primarily closed in Fourteen of the Fifteen patients. Eight patients received post-surgery irradiation. Results: All the flaps survived and healed and withstood radiation well. Two patients had flap dehiscence from suture line, of which one needed reattachment while other a minor one healed by itself and one patient had occasional drooling. There was no difficulty in eating or swallowing. Conclusions: A random patterned TIFCIF based on superficial subdermal adipofascial microcirculation, formed of a rich vascular plexus in the face and neck region can provide a simple alternative for intraoral reconstruction.

KEY WORDS

A turned in fasciocutaneous island flap - oral cancer reconstruction - turned in fasciocutaneous island flap - vascularity of face

• REFERENCES

• 1 Yadav P. Reconstructive surgery in oral cancers. Indian J Plast Surg 2007; 40 Suppl S1 22-7
• 2 Yadav P. Reconstructive surgery in oral cancers. Indian J Plast Surg 2013; 46: 275-82
• 3 Sharp GS, Helsper JT. Intra-oral cancer. The use of skin grafts in the management of the condition. Calif Med 1964; 100: 332-5
• 4 Aryan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63: 73-81
• 5 Kuriakose MA, Sharma M, Iyer S. Recent advances and controversies in head and neck reconstructive surgery. Indian J Plast Surg 2007; 40 Suppl S1 3-12
• 6 Bhathena HM, Kavarana NM. Bipaddled, extended radial forearm flap with microarterial anastomosis for reconstruction in oral cancer. JPRAS 1988; 41: 354-7
• 7 Lewis MB, Remensnyder JP. Forehead flap for reconstruction after ablative surgery for oral and oropharyngeal malignancy. Plast Reconstr Surg 1978; 62: 59-65
• 8 Bakamjian VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg 1965; 36: 173-84
• 9 Nayak BB, Nilamani M. Single stage reconstructions in head and neck surgery using deltopectoral and pectoralis major myocutaneous flaps. Indian J Plast Surg 2012; 45: 151-3
• 10 Bradley P, Brockbank J. The temporalis muscle flap in oral reconstruction. A cadaveric, animal and clinical study. J Maxillofac Surg 1981; 9: 139-45
• 11 Mokal NJ, Ghalme AN, Kothari DS, Desai M. The use of the temporoparietal fascia flap in various clinical scenarios: A review of 71 cases. Indian J Plast Surg 2013; 46: 493-501
• 12 Futrell JW, Johns ME, Edgerton MT, Cantrell RW, Fitz-Hugh GS. Platysma myocutaneous flap for intraoral reconstruction. Am J Surg 1978; 136: 504-7
• 13 Futrell JW, Robson JA. The platysma musculocutaneous flap: Experience with 24 cases. Plast Reconstr Surg 1983; 72: 322-3
• 14 Hurwitz DJ, Rabson JA, Futrell JW. The anatomic basis for the platysma skin flap. Plast Reconstr Surg 1983; 72: 302-14
• 15 Coleman 3rd JJ, Jurkiewicz MJ, Nahai F, Mathes SJ. The platysma musculocutaneous flap: Experience with 24 cases. Plast Reconstr Surg 1983; 72: 315-23
• 16 Tessier P, Matthews DC, Kamerer Jr. D, Ciminello FS, Gargano F, Wolfe SA. Platysma-based myocutaneous clavicular island flap for intraoral reconstruction. Ann Plast Surg 2011; 67: S55-69
• 17 Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: Anatomic study and clinical applications. Plast Reconstr Surg 2000; 105: 2287-313
• 18 Imanishi N, Nakajima H, Kishi K, Chang H, Aiso S. Is the platysma flap musculocutaneous? Angiographic study of the platysma. Plast Reconstr Surg 2005; 115: 1018-24