Anterolateral Thigh Perforator Free Flap Transplantation For Repairing Of Soft Tissue Defects In Oral & Maxillofacial Region

Objective:To investigate the method, effectiveness and clinical application of anterolateral thigh perforator free flaps transplantation for reconstruction of soft tissue defects of oral maxillofacial region.Methods:After general anaesthesia with trachea intubation, a two-team approach was used for resection of the tumor and harvest of the free flap simultaneously or successively. The oral maxillofacial surgeon removed the tumor, and stitched the flap with tissues around defects. And the hand surgeons harvested the flaps, and did microvascular anastomosis. Incision of the skin and subcutaneous tissue was carried out along the periphery of the flap, then divide and separate subcutaneous tissue layer from deep fascia layer little by little carefully and slowly to preserve one major perforating branches. Retrograde dissection and trace the major perforating branches through the deep fascia, muscle tissue, until length and diameter of pedicled blood vessels were enough for anastomosis with the blood vessels in the recipient sites. The incision of donor sites could be primary sutured. The surgeons sutured the edges between the flap and defects first, then anastomosed blood vessels with 8-0 nylon sutures under microscope. Healing condition was observed after operation. Meanwhile, whether skin flap had necrosis and wound was broken were observed at the same time, Clinical data was obtained from different ways, such as the reference of clinical records, telephone follow-up and return visit, preoperative and postoperative photographs.Result:4 perforator flaps survived completely.1 case failed, so he had an Emergency operation,and we found thrombus within stoma, and instead we use forearm flap to repair the defect, and succeeded. Primary wound healing was achieved(stage I)in all the donor sites and the recipient site. Appearance and function of oral is good. After wound healing, there was no significant scaring, and no effect on the lower limb weight bearing and walking.Conclusion:anterolateral thigh perforator free flap grafting is an acceptable technique for reconstruction of oral maxillofacial soft tissue defects. But the operation is more difficult than harvesting forearm flap, so it requires the surgeon have a high degree of operation.