Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 PENG Hanwei , LIN Jianying , GUO Haipeng , LIU Muyuan

Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou Guangdong, 515031, P.R.China;

Corresponding?author：

PENG Hanwei, Email: penghanwei@126.com

Keywords：

Mandible; deep circumflex iliac artery; iliac-internal oblique musculofascial chimeric flap; oral neoplasm

DOI：

10.7507/1002-1892.201806023

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T₃N₁M₀ in 2 cases, T₃N₂M₀ in 1 case, T₄N₀M₀ in 2 cases, and T₄N₂M₀ in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T₄N₀M₀), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.

Citation： PENG Hanwei, LIN Jianying, GUO Haipeng, LIU Muyuan. Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1567-1571. doi: 10.7507/1002-1892.201806023 Copy

1.	徐立群. 下頜骨重建的原則與規范. 中華臨床醫師雜志 (電子版), 2012, 6(19): 5783-5785.
2.	王寧, 黎明. 頜骨缺損后下頜骨重建方法及新材料研究進展. 中國實用口腔科雜志, 2010, 3(1): 54-57.
3.	劉秉堯, 張月, 戴寧, 等. 計算機輔助 3D 打印技術在下頜骨重建的應用. 電子技術與軟件工程, 2015, 4(22): 167.
4.	Kakarala K, Shnayder Y, Tsue TT, et al. Mandibular reconstruction. Oral Oncol, 2018, 77: 111-117.
5.	Lonie S, Herle P, Paddle A, et al. Mandibular reconstruction: meta-analysis of iliac-versus fibula-free flaps. ANZ J Surg, 2016, 86(5): 337-342.
6.	何悅, 侯勁松, 李曉光, 等. 下頜骨放射性骨壞死臨床診療專家共識. 中國口腔頜面外科雜志, 2017, 15(5): 445-456.
7.	陳潔, 蔣燦華, 閔安杰, 等. 旋髂深動脈穿支嵌合髂骨皮瓣修復下頜骨復合性缺損. 華西口腔醫學雜志, 2015, 33(3): 276-280.
8.	Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
9.	Urken ML, Vickery C, Weinberg H, et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch Otolaryngol Head Neck Surg,, 1989, 115(3): 339-349.
10.	Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
11.	胡永杰, 李思毅, 張志愿, 等. 復合髂骨肌皮瓣同期顴種植重建上頜骨缺損一例. 中國修復重建外科雜志, 2005, 19(10): 807-810.
12.	Iida T, Narushima M, Yoshimatsu H, et al. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1596-1599.
13.	Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
14.	Bergeron L, Tang M, Morris SF. The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest. Plast Reconstr Surg, 2007, 120(1): 252-258.
15.	何志湘, 劉鳴江, 謝松林, 等. 成人旋髂深動脈穿支皮瓣嵌合髂骨瓣的應用解剖研究. 現代醫藥衛生, 2016, 32(22): 3488-3490.
16.	Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck, 1996, 18(5): 412-421.

1. 徐立群. 下頜骨重建的原則與規范. 中華臨床醫師雜志 (電子版), 2012, 6(19): 5783-5785.
2. 王寧, 黎明. 頜骨缺損后下頜骨重建方法及新材料研究進展. 中國實用口腔科雜志, 2010, 3(1): 54-57.
3. 劉秉堯, 張月, 戴寧, 等. 計算機輔助 3D 打印技術在下頜骨重建的應用. 電子技術與軟件工程, 2015, 4(22): 167.
4. Kakarala K, Shnayder Y, Tsue TT, et al. Mandibular reconstruction. Oral Oncol, 2018, 77: 111-117.
5. Lonie S, Herle P, Paddle A, et al. Mandibular reconstruction: meta-analysis of iliac-versus fibula-free flaps. ANZ J Surg, 2016, 86(5): 337-342.
6. 何悅, 侯勁松, 李曉光, 等. 下頜骨放射性骨壞死臨床診療專家共識. 中國口腔頜面外科雜志, 2017, 15(5): 445-456.
7. 陳潔, 蔣燦華, 閔安杰, 等. 旋髂深動脈穿支嵌合髂骨皮瓣修復下頜骨復合性缺損. 華西口腔醫學雜志, 2015, 33(3): 276-280.
8. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
9. Urken ML, Vickery C, Weinberg H, et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch Otolaryngol Head Neck Surg,, 1989, 115(3): 339-349.
10. Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
11. 胡永杰, 李思毅, 張志愿, 等. 復合髂骨肌皮瓣同期顴種植重建上頜骨缺損一例. 中國修復重建外科雜志, 2005, 19(10): 807-810.
12. Iida T, Narushima M, Yoshimatsu H, et al. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1596-1599.
13. Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
14. Bergeron L, Tang M, Morris SF. The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest. Plast Reconstr Surg, 2007, 120(1): 252-258.
15. 何志湘, 劉鳴江, 謝松林, 等. 成人旋髂深動脈穿支皮瓣嵌合髂骨瓣的應用解剖研究. 現代醫藥衛生, 2016, 32(22): 3488-3490.
16. Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck, 1996, 18(5): 412-421.

Chinese Journal of Reparative and Reconstructive Surgery

Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content