Reconstructing through-and-through cheek defects using transposing cervicofacial and anterolateral thigh flaps-comparative analysis of aesthetic and functional outcomes.

Abstract

Despite extensive efforts to restore through-and-through cheek defects caused by oral cavity malignancies, surgeons continue to explore optimal approaches to achieving satisfactory cosmetic and functional outcomes. In this prospective randomized controlled study, we share our experience with a modified flap technique, involving the transposition of cervicofacial and anterolateral thigh flaps to repair through-and-through cheek defects. A total of 41 patients with oral squamous cell carcinoma involving the cheek underwent radical excision of buccal carcinoma and reconstruction with a chimeric anterolateral thigh bi-paddles flap. The patients were randomly divided into 2 groups: the "flap transposing" group (n = 21) and the "traditional surgery" group (n = 20). The research data was collected through physical examinations and questionnaires, with postoperative assessments including flap-biting evaluation, the Medical Outcome Study Short Form 36 (MOS SF-36), and the Teacher Drooling Scale. The "flap transposing" group demonstrated significantly higher MOS SF-36 scores for social function, role emotion, mental health, and vitality compared to the "traditional surgery" group. In addition, improved salivation control and decreased flap-biting were observed in the "flap transposing" group. In conclusion, for the repair of through-and-through cheek defects using a chimeric anterolateral thigh bi-paddles flap, transposing the cervicofacial flap to the cheek defect while positioning the flap lobe for skin defects in the submandibular region may significantly enhance esthetic outcomes and improve patients' quality of life.