Oral Cavity And Oropharynx

Reconstruction of soft tissue defects involving mucosa and underlying musculature within the oral cavity and oropharynx can be completed with skin grafts, acellular dermal grafts, mus-culocutaneous flaps, or free flaps in one stage. The literature documents the efficacy of skin grafts for these reconstructions.13-15 Some investigators are hesitant to rely on a thin skin graft as a barrier to saliva drainage into the tissues of the neck of an incompletely healed wound. This hesitance forces the surgeon to decide between the appropriateness of the musculocutaneous flap or free flap. Both can be used effectively. There are those who claim that the bulk of the musculocutaneous flaps can be a deterrent to successful reconstruction. However, the literature has demonstrated that the oral cavity and oropharynx can be functionally restored with the musculocutaneous flaps.16-18 There is certainly information that suggests that the transfer of sensate free flaps can potentially enhance swallowing function.19-22 However, this matter is a classic example of an unresolved issue.

We tend to favor musculocutaneous flaps for partial oral cavity and oropharyngeal reconstructions as one-stage reconstructions that achieve the ability to restore function in a cost-effective fashion. There are certainly times when free flaps appear to be clinically advantageous. Because they are not tethered by a pedicle, free microvascular musculocutaneous flaps have a theoretical advantage in larger tongue defects in maintaining mobility. Free flaps also avoid donor site morbidity associated with musculocutaneous flaps, such as the pectoralis major flap, which may be a concern among female patients.

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