Lining the mouth floor with prelaminated fascio-mucosal free flaps: clinical experience

Soft-tissue defects of the mouth floor need thin, foldable, and pliable tissues able to preserve local anatomy as well as chewing, phonation, and deglutition. The oral mucosa is made of a stratified, nonkeratinized, epithelium-secreting mucus, which lubricates the oral cavity and facilitates tongue movements. No flap exists that can reproduce the physiology of the oral mucosa better than the oral mucosa itself. Prefabrication of mucosal flaps may represent the best solution. Therefore, 10 consecutive cases of mouth floor cancer were treated with prelamination of the fascia antibrachialis with mucosal grafts obtained from the healthy cheek, and with subsequent transplantation 3 weeks later. A significant increase in mucosal graft surface was seen in all cases, with a mean size twice the original. All flaps healed uneventfully. Follow-up time ranged between 2-60 months (average, 26.6 months). Morphological and functional results were excellent. Tongue motility, speech intelligibility, and swallowing were reestablished in all treated cases. Mucosal prelamination of the forearm fascia is feasible and allows physiological reconstruction of oral cavity defects up to 6 x 4 cm.