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The application of chimeric deep circumflex iliac artery perforator flap for oromandibular reconstruction: A case
Chengyao Zhang1, Yi Zeng2, Lian Zhou1
1Department of Head and Neck Cancer Center.
Rationale:
The free fibular flap is considered the gold standard, particularly for a mandibular defect combined with a significant soft tissue defect. However, the fibular flap has the disadvantages of a lack of height for postoperative dental restoration and donor site skin graft if the skin paddle is wider than 5 cm. The larger bone and soft tissue defects tend to be reconstructed using either a scapula or a combination of iliac artery and radial free flap. Few cases involving reconstruction using chimeric deep circumflex iliac artery perforator flap (DCIAPF) for mandibular defect combined with more significant soft tissue defects have been reported due to perforator variations. We successfully performed oromandibular reconstruction using chimeric DCIAPF.
Patient Concerns:
A 56-year-old male patient was admitted due to "constant pain in the gradually enlarged right lower gingival mass since the previous four months." The patient had no other obvious symptoms, and no history of diabetes or hypertension was reported. The patient reported long-term smoking and drinking habits.
Diagnoses:
Computed tomography (CT) revealed a neoplasm in the right buccal space, which is primarily considered a malignancy. The pathological results of a gingival mass biopsy presented squamous cell carcinoma.
Interventions:
No operative contraindications were confirmed after regular tests and examinations were undertaken. The patient underwent a primary extent resection of a 6-cm-long mandible, including mass and suprascapulohyoid neck dissection. The oromandibular defects were then reconstructed with chimeric DCIAPF, simultaneously using the iliac crest bone flap to repair the mandibular lateral segment defect and the skin paddle to repair the intraoral soft tissue defect of 5 × 10 cm.
Outcomes:
The total operating time was five and half hours and blood loss was approximately 500 ml. The operation was successful, with no infections or flap loss. Six months postoperatively, CT showed that the iliac crest bone had connected to the alveolar bone of the mandible. The height of the iliac crest bone was sufficient for postoperative dental restoration. The patient healed without obvious complications and no tumor recurrence.
Lessons:
Chimeric DCIAPF is an excellent option for mandibular angle or body segment defects combined with significant soft tissue defects.
