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

Daniel P Butler1, Jonathan A Dunne1, Simon H Wood1

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Plastic and Reconstructive Surgery. Global Open
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Summary

This study introduces a new algorithm for oral cavity defect reconstruction using free flaps. The algorithm simplifies free flap selection for diverse defects, improving patient outcomes like speech and diet post-surgery.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Existing algorithms for oral cavity defects are limited, often focusing on single subsites or lacking a comprehensive reconstructive approach.
  • A tertiary referral center's experience highlights the need for a unifying algorithm to guide free flap selection in a heterogeneous patient population.

Purpose of the Study:

  • To present a unifying algorithm for free flap selection in the reconstruction of diverse oral cavity defects.
  • To provide a concise and effective guide for surgeons managing complex intraoral defects.

Main Methods:

  • A retrospective review of 118 patients undergoing microvascular reconstruction for intraoral defects between February 2012 and August 2018.
  • Defects were classified by depth (unilaminar, bilaminar, trilaminar) and number/side of mucosal zones involved.

Main Results:

  • The proposed algorithm demonstrated 93% accuracy in guiding flap selection.
  • High success rates were achieved: 98% intelligible speech, 72% return to a normal diet, and 100% flap survival.
  • Specific flap choices correlated with defect types: radial forearm for Type U (1 zone), anterolateral thigh for Type U (≥2 zones) and Type B (≥4 zones), and fibula for Type B (<4 zones).

Conclusions:

  • The developed algorithm offers a straightforward system for reconstructing various oral cavity defects.
  • This approach simplifies decision-making in free flap selection for complex reconstructive challenges.