The Comparative Study Between Free Forearm Flap And Submental Island Flap In Oral Maxillofacial

Objective: Comparison of immediate repair and functional reconstruction between free forearm flap and submental island flap in repairing the tissue defect after resection of oral cancer, evaluation of the clinical value and characteristics of the two flaps.Methods: From June 2013 to September 2016,49 patients with oral cancer, who were hospitalized in the department of oral and maxillofacial surgery of the affiliated stomatological hospital of kunming medical university, were carried out oral cancer radical resection surgery and were repaired the tissue defect immediately with free forearm flap(n=17) or submental island flap(n=32). SPSS21.0 was used to analyze the preoperative data, operation time,and the total amount of exudate, the survival rate of skin flap, the necrosis rate of skin flap, and the satisfaction degree of patients in two groups. The patients were followed up to observe the functional recovery of the recipient and donor sites, and the quality of life of the patients were evaluated by UW-QOL.Result: The study included 49 patients,17 cases with free forearm flap reconstruction and 32 cases with submental island flap reconstruction.Gender, age, pathological grading and follow-up time were similar for both groups. The operation time of Free forearm flap group and submental island flap group is (493.70±93.42) min and(314.93±82.76) min respectively. The operation time of free forearm flap group was significantly higher than that of submental island flap group(P < 0.01).The postoperative exudate amount were(314.70±125.88)ml and(247.31±102.08)ml. The postoperative exudate amount of free forearm flap group was significantly higher than submental island flap group (P < 0.05).The survival rate of free forearm flap group was 88.23% (15/17), lower than the submental island flap group 96.87% (31/32)(P >0.05).Recipient and donor site infection and necrosis rate of free forearm flap group was 29.41%(5/17), higher than the submental island flap group 3.12% (1/32) (P <0.05).Statistics showed that two groups of patients with the recovery of recipient were basically similar, but for the donor sites showed that the free forearm flap group pigmentation, numbness feeling and temporary dysfunction rate in free forearm flap group were was significantly higher than those in the submental island flap group(P <0.05).By using UW-QOL statistics showed that there was no significant difference in quality of life between the two groups (P > 0.05).Patients satisfaction with free forearm flap group was 58.8% (10/17), lower than the submental island flap group 90.6% (29/32)(P< 0.05).Conclusion: 1.The research shows that the application of free forearm flap and submental island flap can be both used for immediate repair and functional reconstruction after the oral cancer resection. The postoperative quality of life and function of recipient site in two groups of patients were basically similar.2.The time of preparation, postoperative exudate volume, survival rate, skin flap and free skin flap infection and necrosis rate and satisfaction, submental island flap group was significantly better than the free forearm flap group.Application of submental island flap for donor site reduce postoperative pigmentation, numbness or paresthesia and temporary dysfunction, and improve patient satisfaction.If conditions permit, the submental island flap is a good choice, especially in primary hospitals without microsurgical technique. However, patients with cervical lymph node metastasis should be carefully applied to the submental island flap.3.Free forearm flap with long vascular pedicle, diameter thick, flexible flap can be folded, strong anti-infection ability and other advantages, the oral and maxillofacial tissue defect with cervical lymph node prone to early metastasis in patients, free forearm flap can be used.