Free prelaminated fasciomucosal flaps in oral cavity floor reconstruction [Lembi liberi prelaminati fascio-mucosi per la ricostruzione del pavimento del cavo orale]

The Chinese fasciocutaneous flap is the most versatile method for repairing soft tissue defects of the oral cavity. Its slenderness and pliability make it preferable to other free flaps in the reconstruction of mobile structures. Its chief limitations are, however, its unfavourable skin characteristics, which are void of mucosecretory activity, and the presence of cutaneous appendages. The consequent reduction in oral cavity lubrication is responsible for the dry feeling which hinders rehabilitation, irrespective of reconstructive outcome. The softness of the donor region is cosmetically and functionally consistent. Clinical application of tissue prefabrication techniques in reconstructive microsurgery enables the problem to be solved by raising tailored flaps with the same characteristics as the region under repair, affording excellent long-term results. Between February 1997 and February 1999 we produced 6 prefabricated fasciomucosal radial flaps in 6 patients affected by squamous cell carcinoma of the oral cavity floor. Surgery was performed in two separate stages. The first phase consisted of prelamination of the fascia antebrachii by a mucosal graft raised from the cheek. The prelaminated flap was then transferred in the second stage. Complete integration of the mucosal graft took three weeks. On reopening after three weeks, initial dimensions were found in all cases to have increased approximately two-fold. The post-operative period was free of complications in all treated cases. Healing by first intention was achieved in the forearm from which the graft was raised. Patients were followed up for between 12 and 34 months. In 5 cases, morphological outcome was excellent, with preservation of tongue motility and restoration of lateral excavations. In all cases, speech, mastication and deglutition were preserved. To date, all patients are free from illness.