Clinical Application Of Anterolateral Thigh Perforator Flaps In The Reconstruction Of Oral And Maxillofacial Defects And Regiondonor-site Functional Assessment

Objective :The Anterolateral thigh perforator flaps(ALTPF)is the axial flap which is mainly derived from the descending branch of the lateral circumflex femoral artery.Because it aims to minimize donor site morbidity and provide sufficient tissue while providing the reconstructive surgeon with more versatility than other flap types,Anterolateral thigh perforator flaps(ALTPF)is widely applied in the reconstruction of oral and maxillofacial defects.This study aims to research the effect of ALTPF in the reconstruction of oral andmaxillofacial defects and assessment of regiondonor-site function,so as to guide the clinical application.Methods The clinical data were collected from 35 cases with oral and maxillofacial malignant cancers between September 2016 and January 2018 in Department of Oral and Maxillofacial Surgery,affiliated hospital of Qingdao university.After excluding surgical contraindications and performing to perforators with colour duplex sonography(CDS),patients were underwented radical surgery for Oral and maxillofacial malignant tumor and reconstruction using a anterolateral thigh perforator flap.The complications and functions of donor were recorded and the operative techniques of ALTPF elevation were generalized.Results All 34 flaps survived completely and the total survival percentage was 97.1%.The free flaps ranged in size from 12cm×8cm~4cm×5cm.Assessment of perforator signals by CDS predicted the average is 2.17 of each lateral thigh,and there are 76 perforator signals in all 35 people.In the operation,it was found that the positioning accuracy accounted for 75%.The perforators were intramuscular in 74.3percent(26)and septocutaneous in 32 percent(9).Dominant perforator supply to the anterolateral thigh perforator flaps was most commonly from the descending(91 percent),transverse(5.7 percent),or oblique(3.5 percent)branch.4 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery.1flaps were used for the floor of mouth reconstruction.two for the buccal skin,one for the Maxillary sinus.Pathological diagnosis was mainly squamous cell carcinoma(SCC).Donor site wounds were primarily closed in all patients without evident early complications.A total of 71.4%(25/35)of patients answ-ered satisfaction for appearance,sensation and movement a ltogether The walking function was not influenced in all patients.Four people(76-91)have difficulty in upstairs,and the average age is 84.25.88.6%(31/ 35)of patients satisfied with the appea –rance.The donor site sensation was not significantly different among the factors including flap area harvested and perforator types.Conclusions The ALTPF encompasses the advantages of versatility,pliability,and potential for composite tissue replacement.The ALTPF was applicable to all oral and maxillofacial defects,particularly useful in the defects after oral and maxillofacial cancer surgery.CDS was applied to perform perforators because of the non-invasive?economical and accurate.Few patients were bothered by the appearance of the scar because of the hidden donor-site of the free anterolateral thigh flap.The donor site sensation was not significantly different among the factors including flap area harvested.T he movement function was not influenced by The ALTPF.