Clinical Application Of Submental Artery Perforator Flap In The Repair Of Oral Cancer Defect After Surgery

ObjectiveOur objective was to investigate the clinical anatomic characteristics and preparation characteristics of Submental artery perforator flap?SMAPF?,and to analyze the clinical effect of SMAPF in the reconstruction of soft tissue defects in oral cancer surgery.MethodsFrom January 1,2016 to January 1,2018,surgeons used SMAPF to reconstruction oral soft tissue cavity in 16 patients with malignant tumors,including 11 males and5 females.The types and number of tumors were as follows:6 cases of squamous cell carcinoma at the tongue,2 cases of adenoid cystic carcinoma at the oral base,2 cases of mucoepidermoid carcinoma at the palatine,2 cases of squamous cell carcinoma at the oral base,and 4 cases of squamous cell carcinoma at the cheek.The patients ranged in age from 70 to 80 years with an average age of 74.5 years.The patient's medical history ranged from 3 months to 6 months.According to the classification of the Union for InternationalCancer Control?UICC,2002?,there were 2 cases of T₂N₀M₀,2 cases of T₂N₁M₀,10cases of T₃N₀M₀ and 2 cases of T₃N₁M₀ in our study.Before the surgery,we used color doppler ultrasound to locate the main trunk and branches of the facial artery,and marked the position of the submental artery perforator near the anterior belly of the digastric muscle.We designed the size and shape of the flap according to the size of the tumor lesion and the blood supply range of the perforator.During the operation,SMAPF was prepared by using the combination of anterograde and retrograde methods.The preliminary anatomy of the facial artery,submental artery,submental vein reflux and perforator was performed,and then the skin flap was prepared.Next,we performed functional lymph node dissection,and then repaired the defect area with SMAPF.During the operation,the flap area,pedicle length,operation time and venous reflux type were recorded.The patient was discharged about 7¹0 days after surgery.From 3 months to 12 months after surgery,we investigated the appearance effect,speech function,swallowing function,mouth opening degree and recurrence of patients with skin flap repair,and analyzed the clinical application effect of SMAPF.Conclusion1.CDFI showed that there were perforating vessels on both sides of the median line in the submental area of 16 patients,and no vascular embolism or atherosclerotic plaque was found in the blood vessels tested on the affected side.2.Submental artery and vein were observed in the same arteriovenous sheath in 16patients.In addition,4 patients also had non-tight accompanying veins.The main types of venous reflux were as follows:submental vein--facial vein--common facial vein--internal jugular vein?14 cases?;Submental vein into anterior vein and posterior jugular vein?2 cases?.3.The size of SMAPF was?3.0cm-4.5cm?^5.0cm-8.0cm,and the pedicle length was 7.2cm⁸.5cm,with an average of 7.7cm.4.Operation time was from 2 h 30 min to 3 h 20 min,the average time for 2 h 50min?5.Cervical lymph nodes:2 cases of patients were evaluated in phase clinical??T₂N₀M₀?,the other 14 cases were evaluated in phase?(10 cases T₃N₀M₀,4 cases of T_2³N₁M₀).We performed thorough lymph node dissection in 4 patients with cN₁.Postoperative pathological examination onlyone patients with cN₁ showed pN₀.Postoperative pathology showed no occult lymph node metastasis in the remaining 12 patients with cN₀.6.The survival rate of skin flap was 100%in 16 cases.The skin flap of one patient showed local congestion and swelling on the first day after surgery,and no special treatment was given.The skin flap returned to normal after 4-5 days.7.The patients were followed up for 3 to 12 months.The patients got out of bed normally at the first month after the surgery,and the intraoral wound was basically healed at the third month after the surgery.Six months after surgery,the patient's activity and diet were basically restored to normal,and one years after surgery,the patient returned to normal life,and there was no recurrence at present.Conclusion1.The blood vessels of SMAPF are constant and the blood supply is reliable.The length of the pedicle and the area of the flap can meet the needs of soft tissue defects at the base of the mouth,buccal,lingual and palatal.SMAPF is an ideal flap for repairing soft tissue defect of oral and maxillofacial region.2.Compared with the free flap repair method,the operation time of SMAPF is shorter,which meets the needs of patients who cannot tolerate general anesthesia for a long time and reduces the operation risk.3.SMAPF does not carry the anterior belly of digastric muscle and submental lymphatic adipose tissue,which provide tumor safety,but it is still recommended to carry out long-term large sample study.