The microvascular thenar flap as a new possibility for super-thin soft tissue reconstruction in the oral...

We report the first clinical use of a free microvascular thenar flap for reconstruction of intraoral soft tissues. In 9 patients with a recurrent oral squamous cell carcinoma (SCC), a new primary oral SCC, or a defect of the hard palate after radiotherapy, we covered the soft tissue defect, after resection of the tumour or local preparation, with a microvascular thenar flap. All patients had had combined resection and irradiation for treatment of the initial tumour. In every case the thenar flap was harvested from the left forearm. Arteries were anastomosed to cervical arteries on either side. The veins were anastomosed to the deep jugular or subclavian vein. Patients were followed up clinically after 3, 6, and 12 months and radiologically every 6 months. The mean length of the pedicle was 21 cm. The mean width of the flap was 27 mm (range 24-30) and the mean length 37 mm (range 26-49). All anastomoses worked well. All flaps healed without major complications. A thin but stable layer of soft tissue resulted in every case. All patients were able to wear their prostheses. Good functional and aesthetic results were seen at each follow-up visit, and there were no signs of relapse. The microvascular thenar flap is well-suited for reconstruction of thin layers of soft tissue in the oral cavity. The long pedicle and hairlessness are also ideal for covering intraoral defects after previous operations and in necks with few if any vessels. Primary wound closure is possible in many cases.