Colgajo submentoniano en la reconstrucción de cabeza y cuello
DOI:
https://doi.org/10.30944/20117582.1872Palabras clave:
neoplasias de cabeza y cuello, colgajo miocutáneo, trasplante autólogo, trasplante de tejidos, período posoperatorioResumen
Introducción. Los colgajos del territorio de la arteria submentoniana pueden ser utilizados como un colgajo cutáneo, musculofacial y osteocutáneo, realizando cierres primarios del defecto del sitio donante, sin generar defectos funcionales ni estéticos mayores.
Métodos. Describir la experiencia de nuestro equipo quirúrgico, las complicaciones relacionadas con el uso del colgajo y los resultados oncológicos, así como los desenlaces tardíos durante el seguimiento de los pacientes incluidos en el estudio.
Resultados. Se incluyeron veintiún pacientes, con una edad media de 66 años (rango 52 - 86), con patología oncológica de lengua, labio inferior, paladar blando, nariz, órbita y orofaringe. Todos los pacientes fueron sometidos a disección selectiva ipsilateral del cuello, tras la extracción del colgajo y en todos los casos se preservó el nervio mandibular marginal. Se registraron complicaciones como la necrosis parcial. La estancia hospitalaria media fue de 8 días.
Conclusiones. El colgajo de la arteria submentoniana ha mostrado resultados favorables debido a su uso versátil, amplio arco de rotación, color y baja morbilidad del sitio donante. Se recomienda realizar estudios más robustos, que incluyan la experiencia de diversos especialistas en países que compartan las mismas limitaciones técnicas y características sociodemográficas.
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Referencias bibliográficas
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106-30. https://doi.org/10.3322/canjclin.56.2.106
Kerawala C, Roques T, Jeannon JP, Bisase B. Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(Suppl 2):S83-S89. https://doi.org/10.1017/S0022215116000499
de Vicente JC, de Villalaín L, Torre A, Peña I. Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy: A functional assessment of radial forearm versus anterolateral thigh flap. J Oral Maxillofac Surg. 2008;66:2270-5. https://doi.org/10.1016/j.joms.2008.01.018
Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski V. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients? ANZ J Surg. 2005;75:101-5. https://doi.org/10.1111/j.1445-2197.2005.03306.x
Martin D, Pascal JF, Baudet J, Mondie JM, Farhat JB, Athoum A, et al. The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap. Plast Reconstr Surg. 1993;92:867-73.
Sterne GD, Januszkiewicz JS, Hall PN, Bardsley AF. The submental island flap. Br J Plast Surg. 1996;49:85-9. https://doi.org/10.1016/s0007-1226(96)90078-8
Sebastian P, Thomas S, Varghese BT, Iype EM, Balagopal PG, Mathew PC. The submental island flap for reconstruction of intraoral defects in oral cancer patients. Oral Oncol. 2008;44:1014-8. https://doi.org/10.1016/j.oraloncology.2008.02.013
Cariati P, Cabello-Serrano A, Marin-Fernandez AB, Perez de Perceval-Tara M, Juliá MA, Martinez-Lara MI. Is submental flap safe for the oncological reconstruction of the oral cavity? J Stomatol Oral Maxillofac Surg. 2018;119:284-7. https://doi.org/10.1016/j.jormas.2018.06.006
Patel UA, Bayles SW, Hayden RE. The submental flap: A modified technique for resident training. Laryngoscope. 2007;117:186-9. https://doi.org/10.1097/01.mlg.0000246519.77156.a4
Potter S, De Blacam C, Kosutic D. True submental artery perforator flap for total soft-tissue chin reconstruction. Microsurgery. 2012;32:502-4. https://doi.org/10.1002/micr.21983
Matsui A, Lee BT, Winer JH, Laurence RG, Frangioni JV. Submental perforator flap design with a near-infrared fluorescence imaging system: The relationship among number of perforators, flap perfusion, and venous drainage. Plast Reconstr Surg. 2009;124:1098-1104. https://doi.org/10.1097/PRS.0b013e3181b5a44c
Sittitrai P, Srivanitchapoom C, Reunmakkaew D, Yata K. Submental island flap reconstruction in oral cavity cancer patients with level I lymph node metastasis. Br J Oral Maxillofac Surg. 2017;55:251-5. https://doi.org/10.1016/j.bjoms.2016.10.022
Schonauer F, Di Martino A, Nele G, Santoro M, Dell’Aversana Orabona G, Califano L. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly. Int J Surg. 2016;33(Suppl 1):51-6. https://doi.org/10.1016/j.ijsu.2016.05.051
Cinar C, Ogur S, Arslan H, Kilic A. Adding versatility to the reconstruction of intraoral lining: opened pocket method. J Craniofac Surg. 2007;18:198-202. https://doi.org/10.1097/01.scs.0000249356.66720.9b
Valentini V, Saltarel A, Cassoni A, Battisti A, Egidi S. One-stage reconstruction of a defect of the oral commissure and of the cheek with a radial forearm free flap. J Craniofac Surg. 2008;19:1508-11. https://doi.org/10.1097/SCS.0b013e318175f3df
Kesting MR, Hölzle F, Wales C, Steinstraesser L, Wagenpfeil S, Mücke T, et al. Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm: A comparison of perioperative data from 161 cases. Ann Surg Oncol. 2011;18:1988-94. https://doi.org/10.1245/s10434-011-1584-8
Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: Comparison of outcomes. Arch Otolaryngol Head Neck Surg. 2011;137:82-7. https://doi.org/10.1001/archoto.2010.204
Metgudmath RB, Metgudmath AR, Metgudmath VV, Roy B, Das AT. Versatility of pectoralis major myocutaneous flap in oncosurgery and its role in developing countries. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 1):80-4. https://doi.org/10.1007/s12070-012-0535-4
McLean JN, Carlson GW, Losken A. The pectoralis major myocutaneous flap revisited: A reliable technique for head and neck reconstruction. Ann Plast Surg. 2010;64:570-3. https://doi.org/10.1097/SAP.0b013e3181c51f4a
Mehrhof AI, Rosenstock A, Neifeld JP, Merritt WH, Theogaraj SD, Cohen IK. The pectoralis major myocutaneous flap in head and neck reconstruction. Analysis of complications. Am J Surg. 1983;146:478-82. https://doi.org/10.1016/0002-9610(83)90235-0
El-Marakby HH. The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst. 2006;18:41-50.
Magden O, Edizer M, Tayfur V, Atabey A. Anatomic study of the vasculature of the submental artery flap. Plast Reconstr Surg. 2004;114:1719-23. https://doi.org/10.1097/01.prs.0000142479.52061.7d
Kim DH, Won SY, Choi DY, Kim HS, Jung UW, Kim HJ, Hu KS. Topography of the submental artery that should be considered in bleeding during dentoalveolar surgery. J Craniofac Surg. 2012;23:1453-6. https://doi.org/10.1097/SCS.0b013e31824e6d48
Bavitz JB, Harn SD, Homze EJ. Arterial supply to the floor of the mouth and lingual gingiva. Oral Surg Oral Med Oral Pathol. 1994;77:232-5. https://doi.org/10.1016/0030-4220(94)90290-9
Lee JC, Lai WS, Kao CH, Hsu CH, Chu YH, Lin YS. Multiple-parameter evaluation demonstrates low donor-site morbidity after submental flap harvesting. J Oral Maxillofac Surg. 2013;71:1800-8. https://doi.org/10.1016/j.joms.2013.03.018
Chen WL, Li JS, Yang ZH, Huang ZQ, Wang JU, Zhang B. Two submental island flaps for reconstructing oral and maxillofacial defects following cancer ablation. J Oral Maxillofac Surg. 2008;66:1145-56. https://doi.org/10.1016/j.joms.2007.09.023
Behan FC, Rozen WM, Wilson J, Kapila S, Sizeland A, Findlay MW. The cervico-submental keystone island flap for locoregional head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2013;66:23-8. https://doi.org/10.1016/j.bjps.2012.08.027
Vural E, Suen JY. The submental island flap in head and neck reconstruction. Head Neck. 2000;22:572-8. https://doi.org/10.1002/1097-0347(200009)22:63.0.co;2-k
Tan O, Atik B, Parmaksizoglu D. Soft-tissue augmentation of the middle and lower face using the deepithelialized submental flap. Plast Reconstr Surg. 2007;119:873-9. https://doi.org/10.1097/01.prs.0000252002.76466.cf
Demir Z, Kurtay A, Şahin U, Velidedeoğlu H, Çelebioğlu S. Hair-bearing submental artery island flap for reconstruction of mustache and beard. Plast Reconstr Surg. 2003;112:423-9. https://doi.org/10.1097/01.PRS.0000070520.96829.85
Rahpeyma A, Khajehahmadi S, Nakhaei M. Submental artery island flap in reconstruction of hard palate after wide surgical resection of verruccous carcinoma, two case reports. Iran J Otorhinolaryngol. 2013;25:177-81.
Tan O, Kiroglu AF, Atik B, Yuca K. Reconstruction of the columella using the prefabricated reverse flow submental flap: A case report. Head Neck. 2006;28:653-7. https://doi.org/10.1002/hed.20395
Kitazawa T, Harashina T, Taira H, Takamatsu A. Bipedicled submental island flap for upper lip reconstruction. Ann Plast Surg. 1999;42:83-6. https://doi.org/10.1097/00000637-199901000-00014
Koshima I, Inagawa K, Urushibara K, Moriguchi T. Combined submental flap with toe web for reconstruction of the lip with oral commissure. Br J Plast Surg. 2000;53:616-9. https://doi.org/10.1054/bjps.2000.3429
Yilmaz M, Menderes A, Barutçu A. Submental artery island flap for reconstruction of the lower and mid face. Ann Plast Surg. 1997;39:30-5. https://doi.org/10.1097/00000637-199707000-00005
Janssen DA, Thimsen DA. The extended submental island lip flap: an alternative for esophageal repair. Plast Reconstr Surg. 1998;102:835-8. https://doi.org/10.1097/00006534-199809030-00034
Zhang B, Wang JG, Chen WL, Yang ZH, Huang ZQ. Reverse facial-submental artery island flap for reconstruction of oropharyngeal defects following middle and advanced-stage carcinoma ablation. Br J Oral Maxillofac Surg. 2011;49:194-7. https://doi.org/10.1016/j.bjoms.2010.04.009
Wang WH, Hwang TZ, Chang CH, Lin YC. Reconstruction of pharyngeal defects with a submental island flap after hypopharyngeal carcinoma ablation. ORL J Otorhinolaryngol Relat Spec. 2012;74:304-9. https://doi.org/10.1159/000345100
Demir Z, Velidedeoğlu H, Celebioğlu S. Repair of pharyngocutaneous fistulas with the submental artery island flap. Plast Reconstr Surg. 2005;115:38-44.
Abboud O, Shedid D, Ayad T. Reconstruction of the prevertebral space with a submental flap: A novel application. J Plast Reconstr Aesthet Surg. 2013;66:1763-5. https://doi.org/10.1016/j.bjps.2013.04.036
Parmar PS, Goldstein DP. The submental island flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2009;17:263-6. https://doi.org/10.1097/MOO.0b013e32832cee83
Elzahaby IA, Roshdy S, Shahatto F, Hussein O. The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma; a case series from a single Egyptian institution. BMC Oral Health. 2015;15:80. https://doi.org/10.1186/s12903-015-0064-0
Amin AA, Sakkary MA, Khalil AA, Rifaat MA, Zayed SB. The submental flap for oral cavity reconstruction: Extended indications and technical refinements. Head Neck Oncol. 2011;3:51. https://doi.org/10.1186/1758-3284-3-51
Cheng MH, Lin CY, Patel KM. A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap. J Surg Oncol. 2017;115:43-7. https://doi.org/10.1002/jso.24487
Chow TL, Chan TT, Chow TK, Fung SC, Lam SH. Reconstruction with submental flap for aggressive orofacial cancer. Plast Reconstr Surg. 2007;120:431-6. https://doi.org/10.1097/01.prs.0000267343.10982.dc
Yamauchi M, Yotsuyanagi T, Ezoe K, Saito T, Ikeda K, Arai K. Reverse facial artery flap from the submental region. J Plast Reconstr Aesthet Surg. 2010;63:583-8. https://doi.org/10.1016/j.bjps.2009.01.035
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