title: Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation.
abstract: OBJECTIVE
  The purpose of this study was to consider the indications and evaluate the clinical advantages and disadvantages including, results and complications, of immediate reconstruction using a latissimus dorsi (LD) free flap and reconstruction plate (R-plate) in advanced oro-mandibular tumour resection.
  
  
  METHODS
  Our cohort included 116 patients who underwent LD free flap and R-plate reconstruction. Flap survival, postoperative function, donor/recipient site complication and aesthetics were evaluated.
  
  
  RESULTS
  Our series demonstrated a 99.1% flap survival rate. One case required a contralateral LD free flap reconstruction after the initial flap failed due to pedicle kinking. Twelve patients needed the plate to be removed and replaced (n=4, plate fracture; n=2, plate exposure) or definite reconstruction with free fibular flap and implant installation. Donor site complications included seroma accumulation, scarring, and discomfort of the shoulder girdle. The size of the skin paddle ranged from 6 × 10 cm to 12 × 18 cm (12 were double paddled).The facial contour was acceptable without sagging of the flap. The flap was tolerant to irradiation and was resistant to the exposure of the plate at the symphyseal arch.
  
  
  CONCLUSIONS
  Our series of primary reconstruction with LD free flaps and R-plates showed the retention of mandibular function and the reconstruction of considerably large soft tissue can be achieved successfully. This reconstruction scheme can be indicated for large-volume defects in the oro-mandibular area when the area cannot be covered by a single osteocutaneous free flap, has undergone extensive oncologic resection for advanced or high recurrence rate malignancy and when immediate postoperative chemotherapy and/or irradiation is necessary.
authors.affiliation: Department of Oral & Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
authors.forename: Bo-Han
authors.initials: BH
authors.lastname: Li
authors.forename: Hun Jong
authors.initials: HJ
authors.lastname: Jung
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Choi
authors.forename: Soung-Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Myung-Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002921:Cicatrix / Q000209:etiology; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D007574:Jaw Relation Record / Q000295:instrumentation; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008341:Mandibular Prosthesis / Q000009:adverse effects; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D008409:Mastication / Q000502:physiology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000379:methods*; D049291:Seroma / Q000209:etiology; D012785:Shoulder Joint / Q000502:physiology; D013060:Speech / Q000502:physiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D060053:Transplant Donor Site / Q000473:pathology / Q000601:surgery