A comparative study on using superior thyroid artery perforator flaps versus traditional sternocleidomastoid myocutaneous flaps for reconstructions after oral cancer ablation: "New tricks for old dogs"?

Chunyue Ma; Surui Sheng; Yi Shen; Weijin Gao; Thorsen Haugen; Liang Wang; Jian Sun

doi:10.1016/j.oraloncology.2021.105374

A comparative study on using superior thyroid artery perforator flaps versus traditional sternocleidomastoid myocutaneous flaps for reconstructions after oral cancer ablation: "New tricks for old dogs"?

Oral Oncol. 2021 Oct:121:105374. doi: 10.1016/j.oraloncology.2021.105374. Epub 2021 Jun 11.

Authors

Chunyue Ma¹, Surui Sheng¹, Yi Shen², Weijin Gao³, Thorsen Haugen⁴, Liang Wang¹, Jian Sun⁵

Affiliations

¹ Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
² Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address: shenyi_777@126.com.
³ Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁴ Department of Otolaryngology - Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA.
⁵ Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address: jianjian60@yahoo.com.

PMID: 34127385
DOI: 10.1016/j.oraloncology.2021.105374

Abstract

Objectives: To introduce new superior thyroid artery perforator flaps (STAPF), and to compare the clinical outcomes with sternocleidomastoid myocutaneous flaps (SCMMF) for their intraoral applications.

Materials and methods: Between January 2013 and December 2020, forty-three oral cancer patients who received post-oncologic reconstructions with one of these two regional flaps were retrospectively collected. Their techniques and outcomes were compared. All the STAPFs were preprepared with radiologic evaluations.

Results: Despite the common arterial origins, the compositions and harvesting procedures of STAPF and SCMMF were different. Though SCMMFs (n = 23) were designed in rotational styles, most STAPFs (n = 20) were septocutaneous perforator flaps, with 2 chimeric ones. In addition, the sizes of STAPFs were generally larger than those of SCMMFs (p = 0.006). Success rate for STAPFs was much higher, with only three partial cutaneous necroses. Radiotherapy delay was more frequently found in those reconstructed with SCMMFs (P = 0.046), mostly due to fistula formations. Besides, incomplete level IIB dissections were also reported in 9 (20.9%) patients in SCMMF group. In our study, the overall survival was affected by both flap conditions (p = 0.014, 1.333-12.881) and postoperative surgical complications (except fistula) (P = 0.005, 2.240-84.134). Functionally speaking, post-reconstructive speech and neck mobility (p < 0.001) were better in the STAPF group.

Conclusions: With accumulated experiences on the use of locoregional flaps in the neck, STAPF, when well-prepared, can provide superior reconstructive outcomes for various intraoral defects. As a comparison with SCMMF in the same middle region, STAPF is a viable option with higher success rates and oncological safety for oral cancer patients.

Keywords: Myocutaneous flap; Oral cancer; Outcome; Perforator flaps; Postoperative complication; Reconstructive surgical procedures; Sternocleidomastoid muscle.

Publication types

Comparative Study
Letter
Research Support, Non-U.S. Gov't

MeSH terms

Arteries
Humans
Mouth Neoplasms* / surgery
Myocutaneous Flap* / surgery
Perforator Flap* / surgery
Plastic Surgery Procedures*
Retrospective Studies