The Clinical Research Of Modified Pedicled Clavicular Myocutaneous Flap To Reconstruct Complex Operative Defect Of Oral Carcinoma

Objectives:To study a flap (Modified pedicled clavicular myocutaneous flap, MPCMF) for repairing the operative complex mandibular defect accompany with soft tissue after oral carcinoma resection, detect the osseointegration between the bone graft and remained manible, observe its clinical effect and prognosis; To measure the size and study the anatomy of clavicle; Attempt to use a new operation that implantation of dental implant is performed simultaneously; To observe the clavicular figure and function after partial-Clavicle excision, sum up the advantages of MPCMF.Methods:Sixteen patients who had operative defects because of oral carcinomas underwent reconstruction with MPCMF after resection of oral carcinoma; they were all from the first affiliated hospital, college of medicine, Zhejiang University from January 2007 to January 2009. All patients underwent reconstruction with MPCMF after tumorectomy and neck dissection, and four of them underwent implantation of dental implants in the clavicular flaps simultaneously.1. Made a detailed record of case history and related information before the operation, evaluate the size of mass, metastasis of surrounding lymph node or distant organ with the help of clinical examination and auxiliary examination just like computerized tomography (CT) . All cases was classified according to the TNM staging;2. Designed the operation according to preoperative data, frozen biopsy was performed in ten cases to ascertain the diagnosis. In strict accordance with the request of "tumor-free operation", the tumor was resected with the surrounding tissue that including a part of the mandible together. Quick frozen biopsy was performed in all patients to confirm that the remained tissue around the mass was not infiltrated by carcinoma. MPCMF was made according the size of the operative defect, and a part of clavicle was remained in order to maintain clavicular appearance and function. All patients underwent reconstruction with MPCMF in the same period of tumorectomy and neck dissection, and four of them underwent implantation of dental implants in the clavicular flaps simultaneously. Measure the vertical clavicle diameter, anteroposterior diameter and width of muscle attachment at the midpoint of sternocleidomastoid attachment.3. Conventional anti-inflammatory treatment and nasal feeding were carried out during the postoperative time; make sure that a good oral hygiene was maintained. Observe the color and shape of the flap in the oral cavity, the healing of the clavicular region was also checked. The shape and metabolic activity of the clavicular flap together with the location of implants were checked with the help of emission computed tomography ( ECT ) or panoramic film.4. High-quality digital photos taken by digital camera in preoperative, intraoperative, postoperative, and follow-up time were classified and conserved as important data.Results:None of these patients was died postoperatively during the follow-up until now; one case( 6.25%) showed local recurrence resulting in reoperation, and recheck the flap growth regularly, it grows well up to now; A part of the skin paddle underwent necrosis in two patients (12.50%), but it grows well after about 7～10 days, complete necrosis of muscular pedicel or bone flap was never encountered, local fluidity was found in 2 patients ( 12.50% ), and healed after abstraction and local press for 5～7 days, fracture of clavicle was found during the operation in one patient ( 6.25%) , and the remained clavicle was fixed with titanium plate. The clavicular flaps that reconstruct the mandibular defects survived and all the dental implants in the clavicular flaps got good stability without loosening or significant shadow around in the panoramic film. All the patients had good pronunciation and oral diet with no difficulty, the function and stability of neck and shoulder were not significantly destroyed.Conclusion:MPCMF is easy to survive because of good blood supply, it is not only simple to perform, but also doesn't destroy the clavicular figure and function significantly. It's suitable to reconstruct the medium - minisize operative complex defects of oral carcinoma.