Posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAN Mingming , SONG Luwen , MA Zhenghao , WANG Tao , HU Kai , WANG Xuji ,  LI Jiancheng

Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

LI Jiancheng, Email: ljc7426@163.com

Keywords：

Posterior lateral perforator flap in the lower limb; free fibula; maxillary tissue defect; repair and reconstruction

DOI：

10.7507/1002-1892.202410044

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Objective To investigate the effectiveness of posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair. Methods Between December 2018 and December 2023, 16 patients with the maxillary malignant tumors were admitted. There were 10 males and 6 females, with an average age of 64.3 years (range, 54-75 years). There were 7 cases of maxillary gingival cancer, 5 cases of hard palate cancer, and 4 cases of maxillary sinus cancer. According to the 2017 American Joint Committee on Cancer (AJCC) TNM stage, there were 8 cases of stage Ⅲ, 6 cases of stage Ⅳa, and 2 cases of stage Ⅳb. After resection of the lesion, the remaining maxillary defects were classified into class Ⅱa in 3 cases, class Ⅱb in 5 cases, and class Ⅲb in 8 cases according to Brown’s classification. The size of soft tissue defects ranged from 4 cm×3 cm to 8 cm×6 cm. The posterior lateral perforator flap in lower limb in size of 5 cm×4 cm-9 cm×7 cm were harvested to repair soft tissue defects, and free fibula in length of 6-11 cm were used to repair bone defects. The donor sites of the lower limb were sutured directly (6 cases) or repaired with free skin grafting (10 cases). Six patients with positive lymph node pathology were treated with radiotherapy after operation. At 6 and 12 months after operation, the self-assessment was performed by the University of Washington Quality of Survival Questionnaire Form (QUW-4) in five dimensions (facial appearance, swallowing function, chewing function, speech function, and mouth opening), and swallowing function was evaluated by using the Kubota water swallowing test. Results Postoperative pathological examination showed that all patients were squamous cell carcinoma. One patient who was treated with radiotherapy developed osteomyelitis and 1 patient developed venous crisis of skin flap. The rest of the flaps and all skin grafts survived, and the wounds healed by first intention. All patients were followed up 1-5 years (mean, 2.8 years). Two patients died of local recurrence of the tumor at the 4th and 5th years after operation, respectively. Except for the chewing function score and total score at 6 months after operation, which showed significant differences compared to preoperative scores (P<0.05), there was no significant difference in other QUW-4 scale scores between different time points (P>0.05). The patients’ swallowing function evaluated by Kubota water swallowing test reached normal in 4 cases, suspicious in 9 cases, and abnormal in 3 cases at 6 months after operation, and 10, 6, and 0 cases at 12 months after operation, respectively. The swallowing function at 12 months was significantly better than that at 6 months (Z=–2.382, P=0.017). Conclusion The posterior lateral perforator flap in the lower limb combined with free fibula to repair maxillary tissue defects can repair soft and hard tissue defects at the same time, so that the patient’s facial appearance, swallowing function, chewing function, speech function, and mouth opening are satisfactorily restored and the mid-term effectiveness is good.

Citation： YAN Mingming, SONG Luwen, MA Zhenghao, WANG Tao, HU Kai, WANG Xuji, LI Jiancheng. Posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(1): 88-94. doi: 10.7507/1002-1892.202410044 Copy

1.	Colevas AD, Yom SS, Pfister DG, et al. NCCN guidelines insights: Head and neck cancers, version 1. 2018. J Natl Compr Canc Netw, 2018, 16(5): 479-490.
2.	邱思齊, 李玥晗, 劉法昱. 美國國立綜合癌癥網絡腫瘤學臨床實踐指南指導下的口腔癌規范化治療. 華西口腔醫學雜志, 2024, 42(5): 566-571.
3.	Amos SE, Daoud GE, Patel SR, et al. Age and postoperative swallowing function in patients treated for advanced oral cancer: A retrospective study. J Geriatr Oncol, 2024, 15(8): 101841. doi: 10.1016/j.jgo.2024.101841.
4.	Jiang C, Huang J, Lin L, et al. Digitally reconstructed severe trauma-induced oro-maxillofacial defects with free vascularised composite tissue flaps. Br J Oral Maxillofac Surg, 2022, 60(6): 773-778.
5.	李建成, 郭蘊, 崔文靜, 等. 局部中晚期口腔癌治療方式與生存質量的分析. 癌癥, 2022, 41(9): 434-442.
6.	Tirelli G, Zanelli E, Polesel J, et al. Improvement in survival rates and quality of life among patients surgically treated for squamous cell carcinoma of the oral cavity. J Maxillofac Oral Surg, 2024. doi: 10.1007/s12663-024-02289-z.
7.	Kurosawa K, Sato N, Ohkoshi A, et al. Multiple buttresses reconstruction of maxilla with fibular flap using computer-aided design/computer-aided manufacturing after maxillectomy. Plast Reconstr Surg Glob Open, 2024, 12(6): e5914. doi: 10.1097/GOX.0000000000005914.
8.	Kwon DK, Kim J, Paeng J, et al. Reconstruction of maxilla and midface defect using fibular free flap. International Journal of Oral and Maxillofacial Surgery, 2024, 52(S2): 180. doi: 10.1016/j.ijom.2023.10.499.
9.	宋麗娜, 吳春月, 秦清巖, 等. 不同類型血管化游離腓骨瓣修復下頜骨缺損的回顧性分析. 口腔頜面外科雜志, 2023, 33(2): 104-110.
10.	Brown JS, Rogers SN, McNally DN, et al. A modified classification for the maxillectomy defect. Head Neck, 2000, 22(1): 17-26.
11.	王娜, 譚麗雙, 李宇. 口腔癌患者術后吞咽障礙評價與其早期預后的相關性研究. 中國實用口腔科雜志, 2021, 14(1): 81-84.
12.	李建成, 陳傳俊, 薛浩偉, 等. 2015—2020年安徽皖北地區口咽癌發病與死亡分析. 中華全科醫學, 2022, 20(8): 1411-1414,1422.
13.	Christopher H, Maddie T, Wesley E, et al. The medial sural artery perforator flap: translation from anatomic study to clinical application for lower extremity reconstruction. Eur J Plast Surg, 2023, 46(6): 1265-1272.
14.	崔文靜, 卓鳳, 王續紀, 等. 游離小腿后外側腓動脈穿支皮瓣修復口咽癌術后缺損的效果分析. 臨床耳鼻咽喉頭頸外科雜志, 2023, 37(1): 52-58, 62.
15.	Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore), 2020, 99(50): e23590. doi: 10.1097/MD.0000000000023590.
16.	郭蘊, 崔文靜, 宗開洋, 等. 紅外熱成像技術輔助腓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, 2022, 36(8): 1015-1020.
17.	楊東昆, 李建成, 吳志剛, 等. 游離腓動脈嵌合穿支皮瓣修復腮腺癌晚期局部病變術后缺損. 中國修復重建外科雜志, 2022, 36(1): 79-85.
18.	王續紀, 卓鳳, 劉森, 等. 游離腓動脈分葉穿支皮瓣在口腔癌術后復合性缺損中臨床應用研究. 臨床耳鼻咽喉頭頸外科雜志, 2024, 38(8): 737-742.
19.	李建成, 宋培軍, 楊東昆, 等. 游離腓動脈雙葉穿支皮瓣在晚期口咽癌術后缺損解剖重建中的臨床效果. 南方醫科大學學報, 2020, 40(6): 814-821.
20.	Song P, Li J, Yang D, et al. Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap. Br J Oral Maxillofac Surg, 2023, 61(2): 176-180.

1. Colevas AD, Yom SS, Pfister DG, et al. NCCN guidelines insights: Head and neck cancers, version 1. 2018. J Natl Compr Canc Netw, 2018, 16(5): 479-490.
2. 邱思齊, 李玥晗, 劉法昱. 美國國立綜合癌癥網絡腫瘤學臨床實踐指南指導下的口腔癌規范化治療. 華西口腔醫學雜志, 2024, 42(5): 566-571.
3. Amos SE, Daoud GE, Patel SR, et al. Age and postoperative swallowing function in patients treated for advanced oral cancer: A retrospective study. J Geriatr Oncol, 2024, 15(8): 101841. doi: 10.1016/j.jgo.2024.101841.
4. Jiang C, Huang J, Lin L, et al. Digitally reconstructed severe trauma-induced oro-maxillofacial defects with free vascularised composite tissue flaps. Br J Oral Maxillofac Surg, 2022, 60(6): 773-778.
5. 李建成, 郭蘊, 崔文靜, 等. 局部中晚期口腔癌治療方式與生存質量的分析. 癌癥, 2022, 41(9): 434-442.
6. Tirelli G, Zanelli E, Polesel J, et al. Improvement in survival rates and quality of life among patients surgically treated for squamous cell carcinoma of the oral cavity. J Maxillofac Oral Surg, 2024. doi: 10.1007/s12663-024-02289-z.
7. Kurosawa K, Sato N, Ohkoshi A, et al. Multiple buttresses reconstruction of maxilla with fibular flap using computer-aided design/computer-aided manufacturing after maxillectomy. Plast Reconstr Surg Glob Open, 2024, 12(6): e5914. doi: 10.1097/GOX.0000000000005914.
8. Kwon DK, Kim J, Paeng J, et al. Reconstruction of maxilla and midface defect using fibular free flap. International Journal of Oral and Maxillofacial Surgery, 2024, 52(S2): 180. doi: 10.1016/j.ijom.2023.10.499.
9. 宋麗娜, 吳春月, 秦清巖, 等. 不同類型血管化游離腓骨瓣修復下頜骨缺損的回顧性分析. 口腔頜面外科雜志, 2023, 33(2): 104-110.
10. Brown JS, Rogers SN, McNally DN, et al. A modified classification for the maxillectomy defect. Head Neck, 2000, 22(1): 17-26.
11. 王娜, 譚麗雙, 李宇. 口腔癌患者術后吞咽障礙評價與其早期預后的相關性研究. 中國實用口腔科雜志, 2021, 14(1): 81-84.
12. 李建成, 陳傳俊, 薛浩偉, 等. 2015—2020年安徽皖北地區口咽癌發病與死亡分析. 中華全科醫學, 2022, 20(8): 1411-1414,1422.
13. Christopher H, Maddie T, Wesley E, et al. The medial sural artery perforator flap: translation from anatomic study to clinical application for lower extremity reconstruction. Eur J Plast Surg, 2023, 46(6): 1265-1272.
14. 崔文靜, 卓鳳, 王續紀, 等. 游離小腿后外側腓動脈穿支皮瓣修復口咽癌術后缺損的效果分析. 臨床耳鼻咽喉頭頸外科雜志, 2023, 37(1): 52-58, 62.
15. Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore), 2020, 99(50): e23590. doi: 10.1097/MD.0000000000023590.
16. 郭蘊, 崔文靜, 宗開洋, 等. 紅外熱成像技術輔助腓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, 2022, 36(8): 1015-1020.
17. 楊東昆, 李建成, 吳志剛, 等. 游離腓動脈嵌合穿支皮瓣修復腮腺癌晚期局部病變術后缺損. 中國修復重建外科雜志, 2022, 36(1): 79-85.
18. 王續紀, 卓鳳, 劉森, 等. 游離腓動脈分葉穿支皮瓣在口腔癌術后復合性缺損中臨床應用研究. 臨床耳鼻咽喉頭頸外科雜志, 2024, 38(8): 737-742.
19. 李建成, 宋培軍, 楊東昆, 等. 游離腓動脈雙葉穿支皮瓣在晚期口咽癌術后缺損解剖重建中的臨床效果. 南方醫科大學學報, 2020, 40(6): 814-821.
20. Song P, Li J, Yang D, et al. Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap. Br J Oral Maxillofac Surg, 2023, 61(2): 176-180.

Chinese Journal of Reparative and Reconstructive Surgery

Posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair

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