Orofacial Soft Tissue Reconstruction with Locoregional Flaps in a Health Resource-Depleted Environment: Experiences from Nigeria

Background Reconstruction of orofacial soft tissue defects is often challenging due to functional and aesthetic demands. Despite advances in orofacial soft tissue defect reconstruction using free flaps, locoregional flaps still remain an important option, especially in health resource-depleted environments. This retrospective study highlights our experiences in oral and maxillofacial soft tissue reconstruction using locoregional flaps.

Methods A twenty-three years retrospective analysis of all patients managed in our department was undertaken. Information was sourced from patients' case notes and operating theater records. Data was analyzed using SPSS ver. 16 (SPSS Inc.) and Microsoft Excel 2007 (Microsoft).

Results A total of 77 patients underwent orofacial soft tissue defect reconstruction within the years reviewed. Males accounted for 55 (71.4%) cases and trauma was the main etiological factor in 45 (58.4%) of the patients treated. When sites of defect were considered, the lip, 27 (32.1%), was the most frequent site followed by the nose, 17 (20.2%). Forehead flap, 51 (59.3%), was the most commonly used flap. Complications noted were tumor recurrences at the recipient bed in 3 (3.9%) cases, tumor occurrence at the donor site in 1 (1.3%) case and postoperative infection in 11 (14.3%) cases.

Conclusions Locoregional flaps still have an important role in the rehabilitation of patients with orofacial soft tissue defects. They remain a vital tool in the armamentarium of the reconstructive surgeon, especially in health resource-depleted environments where advanced reconstructive techniques may not be feasible.

Keywords

Health resources - Soft tissue injuries - Face - Surgical flaps

Publication History

Received: 24 October 2015

Accepted: 16 March 2016

Article published online:
20 April 2022

• References

• 1 De Sousa A. Psychological issues in acquired facial trauma. Indian J Plast Surg 2010; 43: 200-205
• 2 Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg 2011; 127: 205S-212S
• 3 Huband M. Prosthetic rehabilitation. Dermatol Clin 2011; 29: 325-330
• 4 Shimizu R, Kishi K. Skin graft. Plast Surg Int 2012; 2012: 563493
• 5 Wysocki AB. D-MW. Enhance your knowledge of skin grafts. OR Nurs 2008; 2: 30-38
• 6 Cunha MS, Nakamoto HA, Herson MR. et al. Tissue expander complications in plastic surgery: a 10-year experience. Rev Hosp Clin Fac Med Sao Paulo 2002; 57: 93-97
• 7 Cho JY, Jang YC, Hur GY. et al. One stage reconstruction of skull exposed by burn injury using a tissue expansion technique. Arch Plast Surg 2012; 39: 118-123
• 8 Chim H, Salgado CJ, Seselgyte R. et al. Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg 2010; 24: 148-154
• 9 Hunt JP, Buchmann LO. The supraclavicular artery flap for lateral skull and scalp defects: effective and efficient alternative to free tissue transfer. J Neurol Surg Rep 2014; 75: e5-e10
• 10 Colletti G, Autelitano L, Tewfik K. et al. Autonomized flaps in secondary head and neck reconstructions. Acta Otorhinolaryngol Ital 2012; 32: 329-335
• 11 Baliarsing AS, Thorat TS, Gupta A. Flap selection in head and neck cancer reconstruction. Int J Otorhinolaryngol Clin 2013; 5: 63-76
• 12 Uchendu OJ. Challenges of practicing histopathology in a developing country: the Nigerian perspective. Ann Biomed Sci 2013; 12: 68-74
• 13 Obuekwe ON, Ojo MA, Akpata O. et al. Maxillofacial trauma due to road traffic accidents in Benin City, Nigeria: a prospective study. Ann Afr Med 2003; 2: 58-63
• 14 Adebayo ET, Ajike SO, Adebola A. et al. Oral and Maxillo-facial soft tissue sarcomas in an Africa population. Niger J Surg 2006; 8: 135-139
• 15 Chan RC, Chan JY. Deltopectoral flap in the era of microsurgery. Surg Res Pract 2014; 2014: 420892
• 16 Rao J, Deora H. Surgical excision with forehead flap as single modality treatment for Basal cell cancer of central face: single institutional experience of 50 cases. J Skin Cancer 2014; 2014: 320792
• 17 Weizman N, Gil Z, Wasserzug O. et al. Surgical ablation and free flap reconstruction in children with malignant head and neck tumors. Skull Base 2011; 21: 165-170
• 18 Pletcher SD, Kim DW. Current concepts in cheek reconstruction. Facial Plast Surg Clin North Am 2005; 13: 267-281
• 19 Strauch B, Vasconez LO, Hall-Findlay EJ. et al. Grabb's encyclopedia of flaps. Boston: Little, Brown; 1990
• 20 Siqueira EJ, Alvarez GS, Laitano FF. et al. Lower lip reconstruction strategies. Rev Bras Cir Plast 2012; 27: 536-541
• 21 Martin PJ, O'Leary MJ, Hayden RE. Free tissue transfer in oromandibular reconstruction: necessity or extravagance?. Otolaryngol Clin North Am 1994; 27: 1141-1150
• 22 Kroll SS, Schusterman MA, Reece GP. Costs and complications in mandibular reconstruction. Ann Plast Surg 1992; 29: 341-347
• 23 Metiboba S. Nigeria's National Health Insurance Scheme: the need for beneficiary participation. Res J Int Stud 2011; 22: 51-56
• 24 Knoetgen 3rd J, Choudry U, Finical SJ. et al. Head and neck reconstruction with a second free flap following resection of a recurrent malignancy. Ann Plast Surg 2005; 55: 378-383
• 25 Pickford MA, Soutar DS. Intraoral reconstruction using a second free flap for recurrent or metachronous carcinoma. Br J Plast Surg 1995; 48: 559-563