Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 PENG Hanwei , LIN Jianying , GUO Haipeng , LIU Muyuan

Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou Guangdong, 515031, P.R.China;

Corresponding author：

PENG Hanwei, Email: penghanwei@126.com

Keywords：

Mandible; deep circumflex iliac artery; iliac-internal oblique musculofascial chimeric flap; oral neoplasm

DOI：

10.7507/1002-1892.201806023

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Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T₃N₁M₀ in 2 cases, T₃N₂M₀ in 1 case, T₄N₀M₀ in 2 cases, and T₄N₂M₀ in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T₄N₀M₀), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.

Citation： PENG Hanwei, LIN Jianying, GUO Haipeng, LIU Muyuan. Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1567-1571. doi: 10.7507/1002-1892.201806023 Copy

1.	徐立群. 下颌骨重建的原则与规范. 中华临床医师杂志 (电子版), 2012, 6(19): 5783-5785.
2.	王宁, 黎明. 颌骨缺损后下颌骨重建方法及新材料研究进展. 中国实用口腔科杂志, 2010, 3(1): 54-57.
3.	刘秉尧, 张月, 戴宁, 等. 计算机辅助 3D 打印技术在下颌骨重建的应用. 电子技术与软件工程, 2015, 4(22): 167.
4.	Kakarala K, Shnayder Y, Tsue TT, et al. Mandibular reconstruction. Oral Oncol, 2018, 77: 111-117.
5.	Lonie S, Herle P, Paddle A, et al. Mandibular reconstruction: meta-analysis of iliac-versus fibula-free flaps. ANZ J Surg, 2016, 86(5): 337-342.
6.	何悦, 侯劲松, 李晓光, 等. 下颌骨放射性骨坏死临床诊疗专家共识. 中国口腔颌面外科杂志, 2017, 15(5): 445-456.
7.	陈洁, 蒋灿华, 闵安杰, 等. 旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损. 华西口腔医学杂志, 2015, 33(3): 276-280.
8.	Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
9.	Urken ML, Vickery C, Weinberg H, et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch Otolaryngol Head Neck Surg,, 1989, 115(3): 339-349.
10.	Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
11.	胡永杰, 李思毅, 张志愿, 等. 复合髂骨肌皮瓣同期颧种植重建上颌骨缺损一例. 中国修复重建外科杂志, 2005, 19(10): 807-810.
12.	Iida T, Narushima M, Yoshimatsu H, et al. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1596-1599.
13.	Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
14.	Bergeron L, Tang M, Morris SF. The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest. Plast Reconstr Surg, 2007, 120(1): 252-258.
15.	何志湘, 刘鸣江, 谢松林, 等. 成人旋髂深动脉穿支皮瓣嵌合髂骨瓣的应用解剖研究. 现代医药卫生, 2016, 32(22): 3488-3490.
16.	Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck, 1996, 18(5): 412-421.

1. 徐立群. 下颌骨重建的原则与规范. 中华临床医师杂志 (电子版), 2012, 6(19): 5783-5785.
2. 王宁, 黎明. 颌骨缺损后下颌骨重建方法及新材料研究进展. 中国实用口腔科杂志, 2010, 3(1): 54-57.
3. 刘秉尧, 张月, 戴宁, 等. 计算机辅助 3D 打印技术在下颌骨重建的应用. 电子技术与软件工程, 2015, 4(22): 167.
4. Kakarala K, Shnayder Y, Tsue TT, et al. Mandibular reconstruction. Oral Oncol, 2018, 77: 111-117.
5. Lonie S, Herle P, Paddle A, et al. Mandibular reconstruction: meta-analysis of iliac-versus fibula-free flaps. ANZ J Surg, 2016, 86(5): 337-342.
6. 何悦, 侯劲松, 李晓光, 等. 下颌骨放射性骨坏死临床诊疗专家共识. 中国口腔颌面外科杂志, 2017, 15(5): 445-456.
7. 陈洁, 蒋灿华, 闵安杰, 等. 旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损. 华西口腔医学杂志, 2015, 33(3): 276-280.
8. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
9. Urken ML, Vickery C, Weinberg H, et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch Otolaryngol Head Neck Surg,, 1989, 115(3): 339-349.
10. Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
11. 胡永杰, 李思毅, 张志愿, 等. 复合髂骨肌皮瓣同期颧种植重建上颌骨缺损一例. 中国修复重建外科杂志, 2005, 19(10): 807-810.
12. Iida T, Narushima M, Yoshimatsu H, et al. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1596-1599.
13. Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
14. Bergeron L, Tang M, Morris SF. The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest. Plast Reconstr Surg, 2007, 120(1): 252-258.
15. 何志湘, 刘鸣江, 谢松林, 等. 成人旋髂深动脉穿支皮瓣嵌合髂骨瓣的应用解剖研究. 现代医药卫生, 2016, 32(22): 3488-3490.
16. Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck, 1996, 18(5): 412-421.

Chinese Journal of Reparative and Reconstructive Surgery

Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects

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