Cervical/Submandibular Dead Space Filling Type Chimeric Anterolateral Thigh Flap Reconstruction for Head and Neck Cancer Surgery

Introduction

Surgical site infection (SSI) occurrence is a common postoperative complication in head and neck cancer surgery. According to a study by Osborn et al., 19.8% of patients who underwent free or pedicled flap reconstruction following head and neck cancer resection were readmitted mainly for SSI with an occurrence rate of 45.2%. In another study Karakida et al. reported that SSI occurred in 40.6% of 276 patients who underwent oral cavity cancer resection followed by free flap reconstruction. Once SSI develops, there is a risk of sudden death due to abscess formation complicated with carotid or vertebral artery stenosis. Dead space formation in the primary excision site as well as cervical and submandibular area due to lymph node dissection is also common in these patients. This dead space formation facilitates the risk of abscess formation. Here we share our experience of using a chimeric anterolateral thigh (ALT) flap as a countermeasure for the aforementioned complications.

Materials and Methods

Fourteen patients who were treated between October 2016 and February 2017 were included in this study. ALT flaps were elevated as cutaneous perforator island flaps and then the pedicled vastus lateralis muscle was added to the distal end of the pedicle to prepare the chimeric flap. The cutaneous island flap was adapted to the resection site defect, then the muscle part was used to fill the dead space in the cervical/submandibular area to prevent effusion accumulation or wound dehiscence. The range of motion of this flap is superior compared with the perforator-only chimeric ALT. Filling dead spaces is possible by adjusting the size of the pedicled muscle.

Results

Mean age of the patients (9 male, 5 female) was 74.5 years and the mean follow-up period was 6.2 months. Primary tumor location was tongue in 3 patients, buccal mucosa in 3 patients, lower gingiva in 4 patients, parotid gland in 3 patients and maxilla for 1 patient. All patients underwent dead space filling type chimeric ALT flap transfer. There were no partial or total flap losses, wound dehiscence or SSI. None of the patients had any motion impairment due to loss of vastus lateralis muscle.

Conclusion

We believe that this application of the ALT flap is a valuable addition to the surgeon’s arsenal. The dead space filling process could be used as a prevention measure for SSI or vessel exposure due to radiation-induced skin damage following radiotherapy. This flap also allows same-site reconstruction if the primary tumor recurs by using the pedicle of the chimeric flap for reattachment of another free flap.

References

1)Osborn HA,Rathi VK,Tjoa T,Goyal N. Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck.Laryngoscope.2018;128:343–9.

2)Karakida K,Aoki T,Ota Y,Yamazaki H. Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital.J Infect Chemother.2010;16(5):334-9.