title: Reconstruction of complex oro-facial defects using the myocutaneous sub-mental artery flap.
abstract: Oro-facial defects require reconstruction that provides suitable colour match and texture. Moreover inner and outer cheek lining and bulk are key considerations. In cases of severe oro-facial infections concomitant mandibular abnormality, for example trismus, can mandate the need for tissue to obturate mandibular defects. We assessed the use of the myocutaneous sub-mental artery flap (MSA) in non-oncological patients with such defects. Twenty two consecutive patients were included in this case series. All patients were survivors of Cancrum Oris (NOMA). Demographic details, nutritional status and co-morbidities were recorded. Defects were classified according to the tissues destroyed; cheek, mandible, oral cavity, lip(s), nose and eye(s). Simultaneous procedures carried out were recorded. The surgical anatomy of the MSA is described. All patients had composite defects of the cheek and oral cavity plus another local anatomical structure. Adjunct procedures such as trismus release were carried out in 18/22 patients. Four patients required a return to theatre. There was no trismus recurrence observed. No flap losses were incurred. The MSA is a robust flap with minimal incidence of major complications. The MSA negates the need for microsurgical tissue transfer. Furthermore the MSA provides adequate bulk to obturate these defects. Future applications of the MSA may include complex oro-facial oncological defects.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom. Electronic address: dan_saleh@hotmail.com.
authors.forename: D B
authors.initials: DB
authors.lastname: Saleh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Fourie
authors.affiliation: Department of Oral and Maxillofacial Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom.
authors.forename: K D
authors.initials: KD
authors.lastname: Mizen
mesh_terms: D000293:Adolescent; D000328:Adult; D002610:Cheek / Q000601:surgery; D002648:Child; D005141:Eyelid Diseases / Q000601:surgery; D005145:Face / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008047:Lip Diseases / Q000601:surgery; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D009055:Mouth / Q000601:surgery*; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D009334:Neck Muscles / Q000098:blood supply / Q000601:surgery; D009336:Necrosis; D009625:Noma / Q000601:surgery*; D009668:Nose Diseases / Q000601:surgery; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D060053:Transplant Donor Site / Q000098:blood supply / Q000601:surgery; D014313:Trismus / Q000601:surgery; D055815:Young Adult
keywords: NOMA; Oro-facial reconstruction; Sub-mental artery flap