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Free flap for reconstruction of oral maxillofacial and head neck defects:Clinical analysis of 2549 cases

HU Yong-jie,QU Xing-zhou,ZHENG Jia-wei,ZHANG Zhi-yuan,TANG You-sheng,ZHANG Chen-ping,ZHU Han-guang,SUN Jian,SHEN Guo-fang,YE Wei-min,LI Jun,QIU Wei-liu. (Department of Oral and Maxillofacial Surgery,Ninth People's Hospital,College of Stomatology,School of Medicine,Shanghai Jiao Tong University. Shanghai 200011,China)  
PURPOSE: To assess the results of different free flaps in reconstruction of oral and maxillofacial defects. METHODS: 2549 patients with 2684 flaps treated during 1979-2006 with vascularized free flaps were involved in this retrospective study. Soft free flaps included forearm flap,latissimus dorsi myocutaneous flap,pectoralis major myocutaneous flap (PMMF),anterial lateral thigh flap and scapular flap et al. Bone flaps included fibular flap,vascularized iliac flap and scapula flap. These flaps were used to reconstruct the defects of the tongue,palate,cheek,floor of mouth,maxilla and mandible. The successful rate was assessed during different periods. RESULTS: The successful rate was from 92% in 1980's to 98.5% nowadays,96.80% in average. The forearm flap was the most common flap in reconstruction of the defects(64.12%),latissimus dorsi myocutaneous and PMMF were always used in reconstruction of combined defects. Bone flaps were used in maxilla and mandibular reconstruction. More than one free flaps were necessarily combined to reconstruct complicated defects. CONCLUSION: Reconstruction with free flap afforded the great possibility for tumor resection. Forearm flap was the best choice for tongue,cheek,floor of mouth reconstruction. Latissimus dorsi myocutaneous and PMMF were the favorite choice for huge bulk defects. Vascularized iliac flap and fibular flap were commonly used for jaw reconstruction. The free flap transplantation was the mainstay of oral and maxillofacial reconstruction. Selection and application of proper flap is important to esthetic and functional rehabilitation.
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