Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Dongkun ,  LI Jiancheng , WU Zhigang , HU Kai , GUO Yun , SUN Yue

Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;

Corresponding author：

LI Jiancheng, Email: ljc7426@163.com

Keywords：

Peroneal artery; chimeric perforator flap; parotid gland carcinoma; local lesion; wound repair

DOI：

10.7507/1002-1892.202106117

Video：

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Objective To investigate the effectiveness of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma (PGC). Methods Between June 2010 and June 2020, 32 patients with advanced local lesions of PGC were treated with extended radical resection. After that, 17 patients were repaired with the free peroneal artery chimeric perforator flaps (trial group) and another 15 patients were repaired with the pedicled pectoralis major myocutaneous flaps (control group). There was no significant difference in gender, age, disease type, histopathological classification, clinical stage, and pathological stage between groups (P>0.05). The size of skin flap in trial group ranged from 7 cm×6 cm to 12 cm×8 cm and the size of soleus muscle flap ranged from 5 cm×3 cm to 6 cm×4 cm. The donor sites were repaired with skin grafting. The size of the pedicled pectoralis major myocutaneous flaps in control group ranged from 9 cm×6 cm to 14 cm×7 cm. The donor sites were sutured directly. The operation time, survival rate of flap, and postoperative survival of patients were recorded and compared between groups. At 1 year after operation, the University of Washington quality of life (UW-QOL) questionnaire was used to evaluate the quality of life of patients in the two groups, including appearance, shoulder movement, sociability, masticatory function, speech function, and mood. Results The operations completed successfully. The operation time was (6.19±0.72) hours in trial group and (6.41±0.71) hours in control group, showing no significant difference between groups (t=–0.863, P=0.395). The survival rate of flap in trial group was 94.1% (16/17); and 1 patient suffered from vascular crisis after operation and was replaced with the pedicled pectoralis major myocutaneous flap. The survival rate of flap in control group was 100%. All grafts survived and the incisions healed by first intention in the two groups. All patients were followed up. The follow-up time was 6-60 months (median, 60 months) in trial group and 7-60 months (median, 60 months) in control group. Cumulative survival rates of patients at 1, 3, and 5 years after operation were 94.1%, 64.7%, and 58.8% in trial group, respectively; 86.7%, 66.7%, and 53.3% in control group, respectively. There was no significant difference in the cumulative survival rate between groups (χ²=0.090, P=0.762). According to the UW-QOL questionnaire at 1 year after operation, the scores of appearance, shoulder movement, sociability, and mood in trial group were significantly higher than those in control group (P<0.05); and there was no significant difference in masticatory function and speech function scores between groups (P>0.05). Conclusion The peroneal artery perforator has an invariable anatomical relationship. Each perforator emits the muscular branch that nourishes the soleus muscle. Therefore, personalized free peroneal artery chimeric perforator flap can be designed according to the tissue defect, and used to repair the defect after advanced local lesions resection in PGC.

Citation： YANG Dongkun, LI Jiancheng, WU Zhigang, HU Kai, GUO Yun, SUN Yue. Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 79-85. doi: 10.7507/1002-1892.202106117 Copy

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2.	Pfister DG, Spencer S, Adelstein D, et al. Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(7): 873-898.
3.	廖圣恺, 李建成, 张凯, 等. 胸锁乳突肌肌瓣修复腮腺肿瘤术后缺损48例效果观察. 中国实用口腔科杂志, 2010, 3(2): 106-107.
4.	Wei W, Qiu Y, Fang Q, et al. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res, 2019, 47(1): 76-83.
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8.	董顺利, 李建成, 宋培军, 等. 腓动脉穿支皮瓣在上颌恶性肿瘤切除后重建组织缺损的临床应用. 中华显微外科杂志, 2019, 42(4): 354-359.
9.	李建成, 宋培军, 杨东昆, 等. 小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损. 中华显微外科杂志, 2019, 42(1): 26-31.
10.	Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357.
11.	李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果. 南方医科大学学报, 2020, 40(6): 814-821.
12.	Wang S, Yin S, Zhang ZL, et al. Quality of life after oral cancer resection and free flap reconstruction. J Oral Maxillofac Surg, 2019, 77(8): 1724-1732.
13.	Han HH, Lee YJ, Moon SH. Foot reconstruction using a free proximal peroneal artery perforator flap: Anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2018, 71(6): 883-888.
14.	Oexeman S, Ward KL. Understanding the arterial anatomy and dermal perfusion of the lower extremity with clinical application. Clin Podiatr Med Surg, 2020, 37(4): 743-749.
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17.	Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore), 2020, 99(50): e23590. doi: 10.1097/MD.0000000000023590.
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25.	Tao L, Zhang D, Zhang M, et al. Clinical behaviours and prognoses of high- and low-risk parotid malignancies based on histology. Eur Arch Otorhinolaryngol, 2019, 276(2): 497-503.
26.	张艳, 郑伟慧, 姜琳. 淋巴结阳性腮腺癌16例临床病理特征及预后因素分析. 肿瘤学杂志, 2019, 25(12): 1103-1106.
27.	Aro K, Ho AS, Luu M, et al. Development of a novel salivary gland cancer lymph node staging system. Cancer, 2018, 124(15): 3171-3180.
28.	Vartanian JG, Gonçalves Filho J, Kowalski LP, et al. An evidence-based analysis of the management of N0 neck in patients with cancer of the parotid gland. Expert Rev Anticancer Ther, 2019, 19(10): 899-908.
29.	Johnston ML, Huang SH, Waldron JN, et al. Salivary duct carcinoma: Treatment, outcomes, and patterns of failure. Head Neck, 2016, 38 Suppl 1: E820-826.

1. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. Switzerland: Springer, 2017: 95-101.
2. Pfister DG, Spencer S, Adelstein D, et al. Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(7): 873-898.
3. 廖圣恺, 李建成, 张凯, 等. 胸锁乳突肌肌瓣修复腮腺肿瘤术后缺损48例效果观察. 中国实用口腔科杂志, 2010, 3(2): 106-107.
4. Wei W, Qiu Y, Fang Q, et al. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res, 2019, 47(1): 76-83.
5. David AP, Seth R, Knott PD. Facial reanimation and reconstruction of the radical parotidectomy. Facial Plast Surg Clin North Am, 2021, 29(3): 405-414.
6. Pham M, Eviston TJ, Clark JR. Reconstruction of limited parotidectomy defects using the dermofat graft. ANZ J Surg, 2017, 87(12): E256-E260.
7. Wei W, Qiu Y, Fang Q, et al. Pectoralis major myocutaneous flap in salvage reconstruction following free flap failure in head and neck cancer surgery. J Int Med Res, 2019, 47(1): 76-83.
8. 董顺利, 李建成, 宋培军, 等. 腓动脉穿支皮瓣在上颌恶性肿瘤切除后重建组织缺损的临床应用. 中华显微外科杂志, 2019, 42(4): 354-359.
9. 李建成, 宋培军, 杨东昆, 等. 小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损. 中华显微外科杂志, 2019, 42(1): 26-31.
10. Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357.
11. 李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果. 南方医科大学学报, 2020, 40(6): 814-821.
12. Wang S, Yin S, Zhang ZL, et al. Quality of life after oral cancer resection and free flap reconstruction. J Oral Maxillofac Surg, 2019, 77(8): 1724-1732.
13. Han HH, Lee YJ, Moon SH. Foot reconstruction using a free proximal peroneal artery perforator flap: Anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2018, 71(6): 883-888.
14. Oexeman S, Ward KL. Understanding the arterial anatomy and dermal perfusion of the lower extremity with clinical application. Clin Podiatr Med Surg, 2020, 37(4): 743-749.
15. Agrawal G, Gupta A, Chaudhary V, et al. Medial sural artery perforator flap for head and neck reconstruction. Ann Maxillofac Surg, 2018, 8(1): 61-65.
16. Sur YJ, Morsy M, Mohan AT, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg, 2016, 137(5): 1615-1628.
17. Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore), 2020, 99(50): e23590. doi: 10.1097/MD.0000000000023590.
18. Wolff KD, Rau A, Kolk A. Perforator flaps from the lower leg for intraoral reconstruction: Experience of 131 flaps. J Craniomaxillofac Surg, 2018, 46(2): 338-345.
19. Brummund D, Chang A. Chimeric free fibula flap: An encounter with aberrant anatomy. Cureus, 2020, 12(8): e10073. doi: 10.7759/cureus.10073.
20. Chauhan S, Chavre S, Chandrashekar NH, et al. Perforator peroneal artery flap for tongue reconstruction. J Maxillofac Oral Surg, 2017, 16(1): 123-126.
21. Gonzalez SR, Hobbs B, Vural E, et al. Functional outcome predictors following mandibular reconstruction with osteocutaneous fibula free flaps: correlating early postoperative videofluoroscopic swallow studies with long-term clinical results. Maxillofac Plast Reconstr Surg, 2019, 41(1): 30. doi: 10.1186/s40902-019-0211-7.
22. Gaillard J, Bourcheix LM, Masquelet AC. Perforators of the fibular artery and suprafascial network. Surg Radiol Anat, 2018, 40(8): 927-933.
23. Tiftikcioglu YO, Gur E, Gurler T. Free hand perforator concept in osteocutaneous free fibula flap through posterior approach. J Craniofac Surg, 2017, 28(2): 559-563.
24. Wilkman T, Husso A, Lassus P. Clinical comparison of scapular, fibular, and iliac crest osseal free flaps in maxillofacial reconstructions. Scand J Surg, 2019, 108(1): 76-82.
25. Tao L, Zhang D, Zhang M, et al. Clinical behaviours and prognoses of high- and low-risk parotid malignancies based on histology. Eur Arch Otorhinolaryngol, 2019, 276(2): 497-503.
26. 张艳, 郑伟慧, 姜琳. 淋巴结阳性腮腺癌16例临床病理特征及预后因素分析. 肿瘤学杂志, 2019, 25(12): 1103-1106.
27. Aro K, Ho AS, Luu M, et al. Development of a novel salivary gland cancer lymph node staging system. Cancer, 2018, 124(15): 3171-3180.
28. Vartanian JG, Gonçalves Filho J, Kowalski LP, et al. An evidence-based analysis of the management of N0 neck in patients with cancer of the parotid gland. Expert Rev Anticancer Ther, 2019, 19(10): 899-908.
29. Johnston ML, Huang SH, Waldron JN, et al. Salivary duct carcinoma: Treatment, outcomes, and patterns of failure. Head Neck, 2016, 38 Suppl 1: E820-826.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma

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