Evaluating the One-stage Islanded Pedicled Nasolabial Flap as an alternative to Free Microvascular Tissue Reconstruction in Composite Soft Tissue

Jayesh Kumar Jha; Mainak Mallik; Santanu Suba; Vikram Chaturvedi

Volume : IX, Issue : IV, April - 2020

Evaluating the One-stage Islanded Pedicled Nasolabial Flap as an alternative to Free Microvascular Tissue Reconstruction in Composite Soft Tissue

Jayesh Kumar Jha, Mainak Mallik, Santanu Suba, Vikram Chaturvedi

Abstract :

INTRODUCTION– Small to moderate sized soft tissue defects of the oral cavity after tumor resection involving tongue, buccal mucosa, floor of mouth require complex reconstruction with a pliable soft tissue bulk and lining epithelium. Free microvascular tissue transfer in the form of radial forearm flap, anterolateral thigh flap or others is required in such cases as ideal tools of reconstruction. The conventional alternative options are primary closure and other workhorse flaps like pectoralis musculocutaneous, deltopectoral, forehead flaps. Hence in small to moderate defects of the oral cavity, when options of higher or extensive reconstructions are not available due to lack of infrastructure or finance, locoregional pedicled tissue transfer like the nasolabial flap provides an excellent alternative. AIMS AND OBJECTIVES– , To evaluate the one stage pedicled nasolabial flap as a viable option of reconstructing versatile, small to medium sized (upto 6cm) soft tissue intra–oral defects following resection of tumors as an alternative to free microvascular tissue reconstruction. METHODOLOGY– In this retrospective, descriptive, purposive, non–randomised study with convenience sampling, patients with Stages I, II and III oral CA involving tongue, buccal mucosa, floor of mouth and gingivobuccal sulcus aged between 20 to 70 years were included in this study, who were counselled, informed consents taken, pre anaesthetic check up done and operated with single stage nasolabial flap with primary closure of the donor site. They were postoperatively monitored for complications and flap viability, discharged and followed up regularly at OPD. RESULTS– Over a study period of 1 year, we operated on 12 patients with intraoral malignancies for whom the post tumor ablative defects were reconstructed with the single–stage nasolabial flap. The site of tumor was tongue in 50% cases, buccal mucosa in 25%, floor of mouth in 16.67%, gingivobuccal sulcus in 8.33% cases. The mean size of defect created after excision of tumor was 5.0x2.92 cm length and eadthwise. Out of 12 flaps 11 flaps survived with excellent results in functional and anatomical restoration of oral cavity in the long term follow up. CONCLUSION– In a developing country with financial constraints, increased patient load and scarcity of resources for higher forms of microvascular free tissue transfer, the one stage pedicled nasolabial flap forms a viable option of reconstructing versatile, small to medium sized (upto 6cm) soft tissue intra–oral defects following resection of tumors with an acceptable donor site scar, functions of deglutition, mastication and speech and simplicity of the procedure without a steep learning curve. Also the flap provided an excellent pliable soft tissue cover which can withstand post–operative radiotherapy well.