title: Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure.
abstract: BACKGROUND
  Bulkiness and unsightly scarring are the major complaints after oral cancer reconstruction with free flap transfer. Some debulking procedures, such as blunt-tipped cannula liposuction or staged excision, can result in some improvement, but these methods do not provide a one-stage procedure for flap thinning and scar revision due to the concern of flap ischemic change. All suction lipectomy methods were applied on flap resurfacing cases; no through-and-through defect case was used. The author used a nonstandard open-tip cannula for liposuction and w-plasty for scar revision in a one-stage operation in oral through-and-through defect cases. This method achieved excellent aesthetic results without complications.
  
  
  METHODS
  From January of 2004 to October of 2006, secondary debulking procedures were performed on 22 patients who had undergone reconstruction with free anterolateral thigh flaps. All flaps were on the cheek for oral cancer through-and-through defect reconstruction. Suction lipectomy with nonstandard open-tip cannula and w-plasty were performed.
  
  
  RESULTS
  All flaps survived well without any partial skin necrosis. Over 85% of patients were satisfied with the outcome.
  
  
  CONCLUSIONS
  This method can provide a one-stage debulking procedure for the cheek through-and-through defect after free flap reconstruction, and it achieves good aesthetic outcomes.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Huang
authors.forename: Sheng-Hua
authors.initials: SH
authors.lastname: Wu
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Wen-Her
authors.initials: WH
authors.lastname: Wang
authors.forename: Ching-Hung
authors.initials: CH
authors.lastname: Lai
authors.forename: I-Feng
authors.initials: IF
authors.lastname: Sun
authors.forename: Sin-Daw
authors.initials: SD
authors.lastname: Lin
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
mesh_terms: D002610:Cheek / Q000601:surgery*; D002921:Cicatrix / Q000601:surgery; D004487:Edema / Q000209:etiology; D004954:Esthetics; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015187:Lipectomy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000601:surgery*; D009062:Mouth Neoplasms / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000473:pathology; D016896:Treatment Outcome