| Background Oral cancer is a common malignant tumor of the head and neck.90% of it is squamous cell carcinoma,which can occur in any part of the mouth or oropharynx,usually involving the tongue,buccal mucosa,lips,gums and oropharynx.It is the sixth most common cancer in the world.Residual tumors caused by the failure of radiotherapy and chemotherapy and regional recurrence of oral cancer pose enormous therapeutic challenges to head and neck surgeons and oncologists.Previous reports have shown that salvage surgery provides better overall survival and tumor control for resectable residual or recurrent tumors than radiotherapy or chemotherapy,and that salvage surgery has become the DE facto standard for the treatment of residual and recurrent cancers 1-3.The lesions with deep invasion of oral cancer often involve masticatory muscles and mandible,and need to remove more tissue.When involving temporalis muscle,in addition to the mandibular branch and parotid gland,the temporalis muscle and the tissue attached to the skull base need to be removed at the same time,often resulting in huge penetrating complex defects,which are very difficult to repair and reconstruct.Traditional pedicled vascular flap: for example,the pectoralis major musculocutaneous flap(PMMP)is obviously insufficient in the repair of large penetrating soft tissue defects.In patients with a history of radical cervical lymph node dissection or who have received high-dose radiotherapy for the neck,it may be difficult to achieve primary healing of the muscle skin and neck 4.Female patients also have obvious breast tissue,which leads to unsatisfactory repair effect,and these breast tissues may cause breast cancer 5.The lower trapezius myocutaneous flap(LTMP)was large enough to repair the defect,and the operation was relatively simple.However,the complication rate caused by partial or complete flap necrosis is between 0%-57%,so this flap is considered as an unreliable repair technique 6.In this case,the anterolateral femoral myocutaneous flap is widely used as the first choice for repairing and reconstructing defects due to its versatility,abundant tissue,sufficient vascular length,minimal donor area injury,and flexible design for carrying different tissue perforatorflaps 7,8.There are many reports on the study of salvage surgery for oral cancer in foreign countries,but there are few reports on the selection of flap for repair and reconstruction after salvage surgery for oral cancer at home and abroad.Therefore,the clinical therapeutic effect of oral and maxillofacial neck reconstruction with free anterolateral thigh chimeric perforator flap(ALTP)in patients undergoing salvage surgery for oral cancer is worth discussing in this study.Objective To explore the clinical significance of free anterolateral thigh chimeric perforator flap in the reconstruction of defects after salvage operation for oral cancer,and to analyze its possible influence on the survival and prognosis of salvage operation for oral cancer in combination with clinical cases and literature.Methods The clinical data of 19 patients with oral squamous cell carcinoma who met the inclusion criteria from July 2008 to March 2020 in the department of oral and maxillofacial surgery of Guangzhou No.1 People Hospital were retrospectively collected.The general clinical data of the patients were statistically analyzed.VAS,degree of mouth opening,swallowing function,speech function and appearance satisfaction were compared before and after the operation,and the flap and survival status of the patients were followed up.The statistical software SPSS22.0 was used for analysis: SPSS22.0 statistical software was used for statistical processing of the data.The clinical data before and after the operation were statistically analyzed.The measurement data consistent with normal distribution and homogeneity of variance were expressed as mean ± standard deviation(x±s).Mann-whitney U test was used for measurement data that did not conform to normal distribution and homogeneity of variance.The enumeration data were expressed as a percentage(%).Chi-square(x2)or Fisher’s exact test was used,and p<0.05 was considered as statistically significant.Graph Pad Prism 8.0 software was used to depict the total survival time survival curve and disease-free survival curve of patients.Disease-free surial is expressed(x±s).Each subgroup disease-free surial differences comparing with independent samples t test and single factor ANOVA analysis,and using multiariable Cox proportional regression models with different gender,degree of tumor differentiation,tumor nature,neck lymph node cleaning way,severity complication,disease-free interval is analyzed,with p < 0.05 for the difference was statistically significant.Results 1.All cases were successfully resected,and all the free anterolateral thigh chimeric perforator flap survived,with good wound tension,no flap cracking,no hematoma,no carotid artery rupture and other complications.here was no local infection in the wound of the donor area of the thigh,the scar was concealed,and there was no obviousdysfunction in the movement of the thigh.According to the data,postoperative VAS score and postoperative mouth opening degree of the patients were significantly improved compared with those before surgery,and the difference was statistically significant(p < 0.05).There was no significant difference in the grade of swallowing function between the two groups(p >,0.05).There was no significant difference in speech function between the patients before and after surgery(p >,0.05).Postoperative appearance satisfaction of the patients was 84.21%,compared with 73.68% before surgery,and the difference was not statistically significant(p > 0.05).2.At the end of the follow-up period,the median survival time of 19 patients after salvage surgery was 13 months,with a 6-month survival rate of 78.9%,a 1-year survival rate of 57.9%,and a 3-year survival rate of 31.6%.The disease-free survival time of 47.4% patients was 1 year after salvage surgery.From the data point of view,singlefactor analysis showed no statistically significant difference in postoperative tumor-free survival between patients of different genders,tumor differentiation stage,tumor nature,cervical lymph node condition,complication severity,and disease-free interval(p>0.05).The difference in tumor-free survival between different age groups was statistically significant(p<0.05).The univariate mentioned above was introduced into Cox proportional risk model regression analysis,and it was found that the independent prognostic factor affecting postoperative disease-free survival time of patients with salvage oral cancer was ≥60 years old.Regardless of univariate or multivariate analysis(Cox regression model),the age of patients ≥60 years old was a risk factor for poor survival and prognosis in salvage surgery.Conclusion 1.Salvage surgery is an effective method for the treatment of advanced oral cancer/recurrent oral cancer,and the use of appropriate repair methods is an important factor for the success of the surgery,and the free anterolateral thigh chimeric perforator flap is an ideal choice for the repair of complex oral and maxillofacial defects.2.The anterolateral thigh chimeric perforator flap has enough tissue to effectively protect the important blood vessels in the neck and fill the huge cavity.It can reconstruct the structure of oral cavity and face functionally,obviously improve the degree of mouth opening and relieve the pain caused by advanced tumors,especially suitable for the repair of tissue defect and the recovery of organ function after the salvage operation of oral and maxillofacial carcinoma.The age of patients ≥60 years was a risk factor for poor survival and prognosis after salvage surgery.There were no significant differences in the incidence gender,tumor stage differentiation,tumor nature,cervical lymph node dissection,complication severity,and disease-free interval. |
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