Buccal reconstruction with free inguinal flap transplantation

Buccal reconstruction of the inguinal free flap for the surgical treatment of buccal cancer. The cheek is located on the side of the face and constitutes the side wall of the mouth. The upper boundary is the lower edge of the humerus and the zygomatic arch; the lower boundary is the lower edge of the mandible; the anterior boundary nasolabial fold, the anterior horn; the posterior border and the pterygopalatine ligament. These include skin, subcutaneous tissue, buccal fascia, buccal muscles, buccal fat, submucosal tissue, and mucous membranes. The subcutaneous tissue is loose, including the branch of the facial nerve and the trigeminal nerve, the facial artery, the anterior vein, and the buccal artery. The parotid duct is open to the buccal mucosa. Cheek cancer invades these structures and surrounding tissues. After surgical resection, it causes defects of different degrees and shapes. It not only affects important functions and appearances such as language, chewing, expression, but also causes psychological and mental trauma to the patient. Therefore, recovery function is required. And a reconstruction of the cheeks that reconciles both the shape and the shape. Treatment of diseases: inguinal granuloma Indication 1. The patient is in good general condition and can withstand this operation. 2. The surgeon has skilled microvascular anastomosis techniques. 3. The flap donor area is more concealed, and the donor site can be directly closed without damaging the main blood vessels, which is suitable for the repair of a wide range of skin defects in the lower cheek. Contraindications 1. The flap has a rich subcutaneous fat and a thick flap, which is used with caution in young women and obese patients. 2. It is prone to necrosis after infection of the flap, and the repair of the wound through the oral cavity should not be used. 3. The vascular pedicle is short, and the upper cheek defect is not used. Use ultrasound Doppler to detect, blood vessels have variants should not be used. Preoperative preparation 1. Surgical microscope and microvascular surgical instruments, surgical instruments are divided into two sets. 2. With fresh blood 600 ~ 900ml, 5% low molecular dextran 500ml, heparin 12500U, for intraoperative use. 3. 1 day before surgery, clean the enema and clean the enema before going to bed. 4. Place the catheter on the morning of the surgery. 5. The skin preparation and preoperative medication of the donor site and the recipient site are the same as the general surgical requirements. Surgical procedure The operation was performed in two simultaneous sessions. The following are examples of buccal squamous cell carcinoma or basal cell carcinoma. Surgical procedures such as incision design, lesion resection, lymphadenectomy, and subcutaneous tunneling. Lesion removal 1 Incision design: normal skin design incision and supracondylar lymphadenectomy incision 1.5 cm outside the tumor boundary. 2 lesion resection: conventional supracondylar lymphadenectomy, but free ligation to retain the facial artery and the vein in front of the in preparation for anastomosis. The skin, subcutaneous tissue, and muscle layer were cut along the design line in the lesion area, and the parotid duct was ligated and labeled for anastomotic repair. Stop bleeding and rinse the wound. 3 Making a subcutaneous tunnel: In the inferior submandibular incision of the buccal defect, the subcutaneous tissue is sharply separated by scissors until the submandibular incision, the width of which is determined by the width of the finger. 2. Inguinal flap cutting 1 Flap incision design: According to the size and shape of the buccal defect, the 2.5cm femoral artery under the inguinal ligament is a point, the anterior superior iliac spine is a point, and the two points of the line are extended outward to the axis, so the connection is medium. The range of flaps required for the shaft design. The upper edge of the flap is only the umbilical flat line, and the lower edge is about 5-7 cm below the anterior superior iliac spine. The inner edge is the femoral artery, and the outer edge is only the midline. The flap was designed with the rotator and the vein as the center, and the methylene blue line was drawn. 2 flap removal: along the design line of the flap, cut the skin and subcutaneous tissue of the additional incision, separate the femoral artery and saphenous vein, dissect the sacral iliac crest, vein, and the superficial temporal artery into the flap before penetrating The sartorius muscle is placed under the sarcolemma and then inserted into the flap. Therefore, a small piece of sartorius muscle is cut, then the flap is cut, and the flap is completely free from the surface of the sarcolemma. 3 suture donor area wound: the recipient area is ready, in the femoral artery, saphenous vein, the circumflex motion, the venous bifurcation, the vascular pedicle is cut, the pedicle is about 5.0cm long. The donor area was separated by subcutaneous sneak and sutured. 3. Flap graft reconstruction 1 anastomotic vessels: free flaps were transplanted into the buccal defect area, and the vascular pedicle was introduced to the submandibular wound through the lower pole tunnel of the buccal defect area. Under the operating microscope (×6), the 9-0 non-invasive suture was used, and the superficial temporal artery and the facial artery, the superficial iliac vein and the anterior vein end were anastomosed. 2 suture wound: the skin edge of the flap and the wound edge of the cheek defect were sutured with a 1-0 suture. The submandibular and buccal wounds are then sutured. 4. Place the negative pressure drainage tube The skin of the neck is made of holes, and the silicone tube is inserted under the flap of the cheek. complication 1. Anastomotic vasospasm, vascular pedicle twist, anastomotic leakage and vascular embolism. 2. Postoperative wound infection, causing partial or even complete necrosis of the flap.