Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Chi , WANG Zeyu , DU Chongli , GAO Tingyi ,  ZHANG Kai , GUO Zhenfei , HAN Rui , ZHANG Chenchen

Department of Stomatology, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

ZHANG Kai, Email: zk29788@163.com

Keywords：

Ulnar artery flap; oral and maxillofacial region; soft tissue defect; super-reflux

DOI：

10.7507/1002-1892.202405042

Video：

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Objective To investigate the characteristics of the clinical application of ulnar artery flap in the repair of oral and maxillofacial soft tissue defects. Methods The clinical data of 12 patients with oral and maxillofacial defects repaired with ulnar artery flap between June 2021 and July 2023 was retrospectively analyzed. Among them, 11 cases were male and 1 case was female; their ages ranged from 28 to 76 years, with a mean age of 54.8 years. The lesions were located in the lateral margin of the tongue in 3 cases, the root of the tongue in 2 cases, the base of the tongue in 4 cases, and the buccal region, upper gingiva, and lower lip in 1 case each. The pathological types were squamous cell carcinoma in 11 cases and adenoid cystic carcinoma in 1 case; according to the TNM staging of the International Union Against Cancer (UICC), there were 5 cases of T₃N₀M₀, 2 cases of T₃N₁M₀, 1 case of T_4aN₀M₀, 1 case of T_4aN₁M₀, 1 case of T_4aN_2bM₀, and 2 cases of T_4aN_2cM₀. After complete resection of the lesion, the defect ranged from 6 cm×3 cm to 8 cm×5 cm. Preoperatively, colour Doppler ultrasound was used to detect the non-dominant forearm, measure the thickness of the subcutaneous fat in the donor area, confirm and mark the ulnar artery and reflux vein, and measure the diameter of the vessels, flow velocity, and the perforator position; intraoperatively, the flap was designed, prepared, anastomosed, and positioned according to the corresponding data. The vessels were all anastommosed with one artery and two veins to form a super-reflux. After complete hemostasis, the defects were repaired with sliding flap (2 cases), direct suture (4 cases), biomembrane (2 cases), or razor thin skin graft (4 cases). Results No vascular crisis occurred after operation, and all the flaps survived in 12 cases. Wounds in the donor site healed by first intention in 10 cases and by second intention in 2 cases. Wounds in the recipient site healed by first intention in all cases. All 12 patients were followed up 5-18 months, with an average of 11.4 months. The colour and texture of the flap were normal. The function of hand and upper limb was evaluated according to the trial standard of upper limb function assessment of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the score was 65-81 (mean, 71.3), and achieved excellent in 1 case and good in 11 cases. The score of Oral Health Impact Scale (OHIP) was 9-18, with an average of 14.2, and the oral function was satisfactory. During the follow-up, 1 case had local recurrence and underwent extended resection again, while the other patients had no recurrence or metastasis. Conclusion For moderate soft tissue defects with complex oral and maxillofacial function, ulnar artery flap repair is effective.

Citation： SONG Chi, WANG Zeyu, DU Chongli, GAO Tingyi, ZHANG Kai, GUO Zhenfei, HAN Rui, ZHANG Chenchen. Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1098-1104. doi: 10.7507/1002-1892.202405042 Copy

1.	Brunetti B, Salzillo R, De Bernardis R, et al. Lower abdominal vs. lateral thigh perforator flaps in microsurgical sarcoma reconstruction: The aesthetics of donor site matters. J Clin Med, 2024, 13(12): 3622. doi: 10.3390/jcm13123622.
2.	Cowan R, Mann G, Salibian AA. Ultrasound in microsurgery: Current applications and new frontiers. J Clin Med, 2024, 13(12): 3412. doi: 10.3390/jcm13123412.
3.	李萌, 杜洪明, 武和明, 等. 改良前臂皮瓣在頭頸部缺損修復中的應用. 實用口腔醫學雜志, 2020, 36(6): 915-918.
4.	趙佳雄, 南欣榮. 股前外側皮瓣與前臂皮瓣修復口咽癌術后缺損的功能評價. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(12): 1107-1110.
5.	鄺藝臻, 黃東, 蘭萬利, 等. 脛后動脈穿支皮瓣設計的應用解剖. 中國臨床解剖學雜志, 2017, 35(3): 252-255.
6.	Harper JL, Gal TJ. Indications and versatility of the posterior tibial artery flap in head and neck reconstruction. Am J Otolaryngol, 2024, 45(3): 104238. doi: 10.1016/j.amjoto.2024.104238.
7.	Sa??r M, Güven E, Cerci Ozkan A, et al. Reduction of the scar burden at the donor area of the radial forearm flap with the aid of an endoscopic pedicle preparation. Ulus Travma Acil Cerrahi Derg, 2023, 29(11): 1296-1302.
8.	Khan U, Hathi K, MacKay C, et al. The complications of osseous reconstruction in the head and neck: A systematic review and meta-analysis. Otolaryngol Head Neck Surg, 2024. doi: 10.1002/ohn.793.
9.	Hekner DD, Roeling TA, Van Cann EM. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction. Int J Oral Maxillofac Surg, 2016, 45(8): 955-959.
10.	Evin N, Selimoglu MN. Reconstruction of multiple lip and facial defects with bipaddle and sensate radial forearm free flap. Ann Plast Surg, 2024, 92(5): 540-548.
11.	王帥, 段維軼, 徐中飛, 等. 前臂尺側穿支皮瓣在口腔頜面-頭頸部缺損修復中的應用. 中國實用口腔科雜志, 2017, 10(12): 715-719.
12.	Li J, Wang W, Lu Y. The key points of vessel anastomosis in free-flap reconstruction. Asian J Surg, 2024, 47(2): 1137-1138.
13.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14.	吳侃, 李巍銘, 鐘亦思, 等. 成都市社區中老年人口腔健康相關生活質量評價及其影響因素分析. 華西口腔醫學雜志, 2022, 40(4): 440-445.
15.	楊果凡, 陳寶駒, 高玉智, 等. 前臂皮瓣游離移植術(附56例報告). 中華醫學雜志, 1981, 61(3): 139-141.
16.	Younis PA, Davis S, Sweedan AO, et al. Volumetric changes in post hemiglossectomy reconstruction with anterolateral thigh free flap versus radial forearm free flap. Int J Oral Maxillofac Surg, 2024, 53(6): 470-474.
17.	Xu Q, Chen PL, Liu YH, et al. Comparing donor site morbidity between radial and ulnar forearm free flaps: a meta-analysis. Br J Oral Maxillofac Surg, 2022, 60(5): 547-553.
18.	羊書勇, 鄭維銀, 李浩, 等. 游離皮瓣修復口腔頜面部組織缺損106例臨床分析. 實用口腔醫學雜志, 2011, 27(6): 798-800.
19.	馬治超, 孫黎波, 周航宇, 等. 折疊游離前臂皮瓣修復頰癌術后洞穿性缺損的臨床研究. 臨床耳鼻咽喉頭頸外科雜志, 2018, 32(13): 1002-1005.
20.	Abdulbaki H, Ha PK, Knott PD, et al. Postoperative inpatient surgical complications following head and neck microvascular free tissue transfer. Head Neck, 2024. doi: 10.1002/hed.27728.
21.	Hakim SG, Trenkle T, Sieg P, et al. Ulnar artery-based free forearm flap: review of specific anatomic features in 322 cases and related literature. Head Neck, 2014, 36(8): 1224-1229.
22.	Hakim SG, Trenkle T, Sieg P, et al. Ulnar artery-based free forearm flap: review of specific anatomic features in 322 cases and related literature. Head Neck, 2014, 36(8): 1224-1229.
23.	Zheng Y, Hallock GG, Levin LS, et al. Mini-shaped kiss flap design for palmar and digital soft-tissue resurfacing. Plast Reconstr Surg, 2024, 153(2): 411-421.
24.	Hakim SG, Jacobsen HC, Trenkle T, et al. Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction. J Craniomaxillofac Surg, 2015, 43(8): 1325-1329.
25.	周家宇, 周國燕, 楊勝波. 成人前臂前群肌的神經入肌點定位及意義. 中國臨床解剖學雜志, 2022, 40(2): 126-131.
26.	王棟, 劉亮, 張凱, 等. 超聲造影技術輔助腹壁淺動脈穿支皮瓣修復口腔頜面部缺損的應用研究. 中國修復重建外科雜志, 2020, 34(11): 1417-1422.
27.	李春潔, 韓波, 朱桂全. 口腔頜面部缺損游離皮瓣修復中血管吻合的技巧及關鍵點. 華西口腔醫學雜志, 2022, 40(3): 271-278.
28.	Chang EI, Liu J. Prospective comparison of donor-site morbidity following radial forearm and ulnar artery perforator flap harvest. Plast Reconstr Surg, 2020, 145(5): 1267-1274.
29.	Al-Aroomi MA, Mashrah MA, Qi Z, et al. Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self-controlled study. Head Neck, 2022, 44(10): 2142-2150.

1. Brunetti B, Salzillo R, De Bernardis R, et al. Lower abdominal vs. lateral thigh perforator flaps in microsurgical sarcoma reconstruction: The aesthetics of donor site matters. J Clin Med, 2024, 13(12): 3622. doi: 10.3390/jcm13123622.
2. Cowan R, Mann G, Salibian AA. Ultrasound in microsurgery: Current applications and new frontiers. J Clin Med, 2024, 13(12): 3412. doi: 10.3390/jcm13123412.
3. 李萌, 杜洪明, 武和明, 等. 改良前臂皮瓣在頭頸部缺損修復中的應用. 實用口腔醫學雜志, 2020, 36(6): 915-918.
4. 趙佳雄, 南欣榮. 股前外側皮瓣與前臂皮瓣修復口咽癌術后缺損的功能評價. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(12): 1107-1110.
5. 鄺藝臻, 黃東, 蘭萬利, 等. 脛后動脈穿支皮瓣設計的應用解剖. 中國臨床解剖學雜志, 2017, 35(3): 252-255.
6. Harper JL, Gal TJ. Indications and versatility of the posterior tibial artery flap in head and neck reconstruction. Am J Otolaryngol, 2024, 45(3): 104238. doi: 10.1016/j.amjoto.2024.104238.
7. Sa??r M, Güven E, Cerci Ozkan A, et al. Reduction of the scar burden at the donor area of the radial forearm flap with the aid of an endoscopic pedicle preparation. Ulus Travma Acil Cerrahi Derg, 2023, 29(11): 1296-1302.
8. Khan U, Hathi K, MacKay C, et al. The complications of osseous reconstruction in the head and neck: A systematic review and meta-analysis. Otolaryngol Head Neck Surg, 2024. doi: 10.1002/ohn.793.
9. Hekner DD, Roeling TA, Van Cann EM. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction. Int J Oral Maxillofac Surg, 2016, 45(8): 955-959.
10. Evin N, Selimoglu MN. Reconstruction of multiple lip and facial defects with bipaddle and sensate radial forearm free flap. Ann Plast Surg, 2024, 92(5): 540-548.
11. 王帥, 段維軼, 徐中飛, 等. 前臂尺側穿支皮瓣在口腔頜面-頭頸部缺損修復中的應用. 中國實用口腔科雜志, 2017, 10(12): 715-719.
12. Li J, Wang W, Lu Y. The key points of vessel anastomosis in free-flap reconstruction. Asian J Surg, 2024, 47(2): 1137-1138.
13. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14. 吳侃, 李巍銘, 鐘亦思, 等. 成都市社區中老年人口腔健康相關生活質量評價及其影響因素分析. 華西口腔醫學雜志, 2022, 40(4): 440-445.
15. 楊果凡, 陳寶駒, 高玉智, 等. 前臂皮瓣游離移植術(附56例報告). 中華醫學雜志, 1981, 61(3): 139-141.
16. Younis PA, Davis S, Sweedan AO, et al. Volumetric changes in post hemiglossectomy reconstruction with anterolateral thigh free flap versus radial forearm free flap. Int J Oral Maxillofac Surg, 2024, 53(6): 470-474.
17. Xu Q, Chen PL, Liu YH, et al. Comparing donor site morbidity between radial and ulnar forearm free flaps: a meta-analysis. Br J Oral Maxillofac Surg, 2022, 60(5): 547-553.
18. 羊書勇, 鄭維銀, 李浩, 等. 游離皮瓣修復口腔頜面部組織缺損106例臨床分析. 實用口腔醫學雜志, 2011, 27(6): 798-800.
19. 馬治超, 孫黎波, 周航宇, 等. 折疊游離前臂皮瓣修復頰癌術后洞穿性缺損的臨床研究. 臨床耳鼻咽喉頭頸外科雜志, 2018, 32(13): 1002-1005.
20. Abdulbaki H, Ha PK, Knott PD, et al. Postoperative inpatient surgical complications following head and neck microvascular free tissue transfer. Head Neck, 2024. doi: 10.1002/hed.27728.
21. Hakim SG, Trenkle T, Sieg P, et al. Ulnar artery-based free forearm flap: review of specific anatomic features in 322 cases and related literature. Head Neck, 2014, 36(8): 1224-1229.
22. Hakim SG, Trenkle T, Sieg P, et al. Ulnar artery-based free forearm flap: review of specific anatomic features in 322 cases and related literature. Head Neck, 2014, 36(8): 1224-1229.
23. Zheng Y, Hallock GG, Levin LS, et al. Mini-shaped kiss flap design for palmar and digital soft-tissue resurfacing. Plast Reconstr Surg, 2024, 153(2): 411-421.
24. Hakim SG, Jacobsen HC, Trenkle T, et al. Impact of body mass index, gender, and smoking on thickness of free soft tissue flaps used for orofacial reconstruction. J Craniomaxillofac Surg, 2015, 43(8): 1325-1329.
25. 周家宇, 周國燕, 楊勝波. 成人前臂前群肌的神經入肌點定位及意義. 中國臨床解剖學雜志, 2022, 40(2): 126-131.
26. 王棟, 劉亮, 張凱, 等. 超聲造影技術輔助腹壁淺動脈穿支皮瓣修復口腔頜面部缺損的應用研究. 中國修復重建外科雜志, 2020, 34(11): 1417-1422.
27. 李春潔, 韓波, 朱桂全. 口腔頜面部缺損游離皮瓣修復中血管吻合的技巧及關鍵點. 華西口腔醫學雜志, 2022, 40(3): 271-278.
28. Chang EI, Liu J. Prospective comparison of donor-site morbidity following radial forearm and ulnar artery perforator flap harvest. Plast Reconstr Surg, 2020, 145(5): 1267-1274.
29. Al-Aroomi MA, Mashrah MA, Qi Z, et al. Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self-controlled study. Head Neck, 2022, 44(10): 2142-2150.

Chinese Journal of Reparative and Reconstructive Surgery

Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap

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