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Simplified Designing and Insetting of the Free Flap in Reconstructing Oral and/or Oropharyngeal Defect

Yoon, Jiyoung MD; Yim, Ji Hong MD; Kim, Eun Key PhD

doi: 10.1097/SCS.0000000000001906
Brief Clinical Studies

Reconstructing oral and/or oropharyngeal defect after tumor ablation requires anatomic restoration of the complex structures to maximize functional outcomes. This study introduces a simple and adjustable way of designing and insetting of a free flap in such reconstruction. Patients who received free flap reconstruction of oral and/or oropharyngeal defect with 33% to 66% of the native tongue left intact after resection of the tumor were enrolled and reviewed. Flap was designed as an oval shape according to the maximum width and length of the defect, and sutured from the most posterior part. Natural imbrication of the flap formed by anterior pulling of the tongue was marked and de-epithelized to create a three-dimensional shape. A total of 30 patients met the inclusion criteria of this study and the median follow-up was 32 months. All flaps survived after 1 case of venous reanastomosis. The average hospital stay was 23.7 days. All patients were decannulated. Twenty (66.7%) patients could eat a normal or soft diet, and 19 (63.3%) patients had normal or intelligible speech. Simplified designing of the flap with adjustable tailoring allowed for easy and effective way of free flap oral and/or oropharyngeal reconstruction. De-epithelization (or trimming) of the naturally imbricated area during the procedure of insetting created a bilobed shape in effect to conform to the three-dimensional defect.

Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Eun Key Kim, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Korea; E-mail:

Received 21 December, 2014

Accepted 22 March, 2015

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.