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Secondary Revision Surgery Using a Tensor Fascia Lata Sling Following Head and Neck Reconstruction
Hitoshi Nemoto1, Kotaro Imagawa1, Daiki Morita1
1Department of Plastic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Background:
Osteocutaneous flaps are the standard approach for performing reconstruction after a mandibulectomy. Soft tissue reconstruction alone may be performed for tumor progression or patient burden; however, it may cause a loss of oral function and issues concerning cosmetic appearance. We performed secondary revision surgery using the tensor fascia lata. This report presents a contour revision surgery for one case in which optimal flap selection was not possible during immediate reconstruction due to various reasons.
Methods:
A 63-year-old woman with idiopathic thrombocytopenic purpura and left lower gingival cancer (pT4a N3, M0, Stage IVa) underwent left hemimandibulectomy and left neck dissection. Reconstruction was performed with a deep inferior epigastric perforator flap. Two years after the surgery, we performed a flap volume reduction and created a tensor fascia lata sling to correct a significant irregularity of the mandibular contour. The mandibular contour was greatly improved after revision surgery, and controlled occlusion was possible. A quality-of-life assessment indicated an improved cosmetic appearance.
Conclusion:
This method is relatively simple and less invasive than bone grafting. It potentially solves some problems associated with mandibular reconstruction using only soft tissue.
