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A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept.

Abstract

Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population.

Methods

All intraoral defects requiring microvascular reconstruction from February 2012 to August 2018 were reviewed. Defects were classified according to their depth as unilaminar (type U = mucosa only), bilaminar (type B = mucosa and bone), or trilaminar (type T = mucosa, bone, and skin) and the number and side of mucosal zones involved (from 1 to 5). Hard palate defects were considered separately and excluded if part of a wider maxillectomy defect.

Results

A total of 118 patients were eligible for inclusion in the study. Of type U defects involving 1 mucosal zone, 98% were reconstructed with a radial forearm free flap. Ninety-two percentage of type U defects involving ≥2 mucosal zones were reconstructed with an anterolateral thigh flap. Among type B defects, 86% were reconstructed with a fibula osseocutaneous free flap if less than 4 mucosal zones were involved and 100% reconstructed with an ALT if ≥4 mucosal zones were involved. The algorithm presented was accurate for 93% of the cases. Ninety-eight percentage of patients achieved intelligible speech and 72% returned to a normal diet. Flap success rate was 100%.

Conclusions

The algorithm presented provides a simple system to guide the reconstruction of oral cavity defects.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London.Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London.Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London.Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31942327

Citation

Butler, Daniel P., et al. "A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept." Plastic and Reconstructive Surgery. Global Open, vol. 7, no. 7, 2019, pp. e2267.
Butler DP, Dunne JA, Wood SH, et al. A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. Plast Reconstr Surg Glob Open. 2019;7(7):e2267.
Butler, D. P., Dunne, J. A., Wood, S. H., & Jallali, N. (2019). A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. Plastic and Reconstructive Surgery. Global Open, 7(7), pp. e2267. doi:10.1097/GOX.0000000000002267.
Butler DP, et al. A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. Plast Reconstr Surg Glob Open. 2019;7(7):e2267. PubMed PMID: 31942327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. AU - Butler,Daniel P, AU - Dunne,Jonathan A, AU - Wood,Simon H, AU - Jallali,Navid, Y1 - 2019/07/24/ PY - 2019/03/02/received PY - 2019/04/02/accepted PY - 2020/1/17/entrez PY - 2020/1/17/pubmed PY - 2020/1/17/medline SP - e2267 EP - e2267 JF - Plastic and reconstructive surgery. Global open JO - Plast Reconstr Surg Glob Open VL - 7 IS - 7 N2 - : Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population. Methods: All intraoral defects requiring microvascular reconstruction from February 2012 to August 2018 were reviewed. Defects were classified according to their depth as unilaminar (type U = mucosa only), bilaminar (type B = mucosa and bone), or trilaminar (type T = mucosa, bone, and skin) and the number and side of mucosal zones involved (from 1 to 5). Hard palate defects were considered separately and excluded if part of a wider maxillectomy defect. Results: A total of 118 patients were eligible for inclusion in the study. Of type U defects involving 1 mucosal zone, 98% were reconstructed with a radial forearm free flap. Ninety-two percentage of type U defects involving ≥2 mucosal zones were reconstructed with an anterolateral thigh flap. Among type B defects, 86% were reconstructed with a fibula osseocutaneous free flap if less than 4 mucosal zones were involved and 100% reconstructed with an ALT if ≥4 mucosal zones were involved. The algorithm presented was accurate for 93% of the cases. Ninety-eight percentage of patients achieved intelligible speech and 72% returned to a normal diet. Flap success rate was 100%. Conclusions: The algorithm presented provides a simple system to guide the reconstruction of oral cavity defects. SN - 2169-7574 UR - https://www.unboundmedicine.com/medline/citation/31942327/A_Unifying_Algorithm_in_Microvascular_Reconstruction_of_Oral_Cavity_Defects_Using_the_Trilaminar_Concept L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=31942327.ui DB - PRIME DP - Unbound Medicine ER -