Retrospective analysis of three different types of tissue flaps in reconstruction of tissue defects of orbital region
10.3760/cma.j.cn114453-20220908-00281
- VernacularTitle:三种不同类型组织瓣修复眶区组织缺损的回顾性分析
- Author:
Xubin WU
1
;
·Maimaiti ABUDUKELIMUJIANG
;
Zhitao YAO
;
·Saimaiti ADILIJIANG
;
·Tuerxun JULAITI
;
Wei AN
;
Tairan DING
;
Simin ZHANG
;
·Tuerdi MAIMAITITUXUN
Author Information
1. 新疆医科大学第一附属医院（附属口腔医院）口腔颌面创伤正颌外科 新疆维吾尔自治区口腔医学研究所 新疆医科大学口腔医学院基础教研室，乌鲁木齐 830054
- Keywords:
Eye neoplasms;
Temporalis myofascial flap;
Anterolateral thigh flap;
Pectoralis major myocutaneous flap;
Reconstructive surgical procedures
- From:
Chinese Journal of Plastic Surgery
2023;39(5):479-489
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of three different tissue flaps in repairing patients with orbital region tissue loss after enlarged resection of malignant tumors in the orbital region, as well as the indication.Methods:Retrospective analysis of data of patients with malignant tumors in the orbital region treated in the Department of Oral and Maxillofacial Trauma and Orthognathic Surgery, the First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital) between January 2017 and December 2021. All patients underwent extensive resection of periorbital malignant tumors and enucleation of orbital contents, depending on defects in periorbital soft/hard tissues and orbital contents, temporalis myofascial flap combined with full thickness skin grafts (TMF-FTSG group), modified pectoralis major myocutaneous flap (PMMF group), and free anterolateral thigh flap (ALTF group) were used to repair the tissue defect. The wound healing and complications of the donor and recipient areas were followed up after operation, and degree of mouth opening in the TMF-FTSG group was compared at 3 months after operation and before operation. The University of Washington quality of life scale (UW-QOL) score was compared among the three groups before and 1 year after operation (a total of 12 items, each item was assigned from 0 to 100 points, the higher the score, the better the recovery). Statistical software SPSS 26.0 was used to analyze the data. The measurement data were expressed as Mean±SD, and the paired t-test was used to compare the preoperative and postoperative data within the group, the difference was statistically significant at a P value less than 0.05. Results:A total of 22 patients were enrolled. There were 8 patients in TMF-FTSG group, 4 males and 4 females, aged (68.3±9.7) years. There were 6 patients in PMMF group, 5 males and 1 female, aged (65.8±7.8) years. There were 3 males and 5 females in ALTF group, aged (63.8±5.4) years. There were 12 cases of squamous cell carcinoma, 8 cases of basal cell carcinoma and 2 cases of adenoid cystic carcinoma. The size of soft tissue defect after tumor resection in TMF-FTSG group, PMMF group and ALTF group was 4 cm×4 cm-7 cm×8 cm, 4 cm×5 cm-9 cm×9 cm and 5 cm×6 cm-14 cm×9 cm, respectively. And the size of flaps ranged from 5 cm×4 cm to 8 cm×9 cm, from 5 cm×7 cm to 10 cm×10 cm, and from 10 cm×6 cm to 20 cm×9 cm, respectively. All donor sites and 20 recipient sites recovered in stage Ⅰ, 2 recipient sites recovered in stage Ⅱ. The patients were monitored for a mean of (27.2 ±13.0) months. During the period of follow-up, one patient, reconstructed with PMMF, died 13 months after surgery due to local tumor recurrence, while the others did not experience metastasis or recurrence. In TMF-FTSG group, the mouth opening was (3.60±0.36) cm 3 months after operation and (3.84±0.15) cm before operation, with no significant difference ( P>0.05). The UW-QOL scores of appearance, mood and anxiety in the three groups 1 year after operation were higher than those before operation ( P<0.05), and the one year after operation’s scores of activity and shoulder were lower than those before operation ( P<0.05). The UW-QOL scores of pain and recreation in TMF-FTSG group one year after operation were higher than those before operation ( P<0.05), the other two groups were also higher than those before operation, but the difference was not statistically significant ( P>0.05). There was no significant difference in the UW-QOL scores of swallowing, chewing, speech, taste, and saliva in the three groups at one year after operation and before operation ( P>0.05). Conclusion:In the repair of tissue defects after operation of malignant tumors in the orbital region, three distinct types of tissue flaps can be utilized to repair tissue defects. TMF-FTSG has certain advantages for patients with minor bone defects, whereas ALTF and PMMF are more appropriate for patients with extensive tissue loss. PMMF is an effective method of repair for patients with a history of radiotherapy and poor vascular health in the recipient area.
