PMC4152256_01
Preoperative view of two primary tumors.. Note that the left tongue cancer (T3N0M0) and left buccal cancer (T2N0M0) were not directly adjacent.
pone.0106326.g001.jpg
PMC4152256_01_pone.0106326.g001.jpg
pone-0106326-g001
Table 1) presented with left tongue cancer (T3N0M0), left buccal cancer (T2N0M0) and extensive mucosa leukoplakia on right tongue (Fig. 1 and 2) underwent a radical ablation of all oral lesions and left functional neck dissection. The resulting defects involved left half tongue, left buccal mucosa ranging from the gingival buccal sulcus of maxilla to left hyomandibular furrow of mandible, and right tongue mucosa (Fig. 3).
Preoperative view of left tongue cancer and right tongue mucosa leukoplakia.. The extensive mucosa leukoplakia (3x4 cm2) of right tongue was indicated to be resected.
pone.0106326.g002.jpg
PMC4152256_01_pone.0106326.g002.jpg
pone-0106326-g002
Table 1) presented with left tongue cancer (T3N0M0), left buccal cancer (T2N0M0) and extensive mucosa leukoplakia on right tongue (Fig. 1 and 2) underwent a radical ablation of all oral lesions and left functional neck dissection. The resulting defects involved left half tongue, left buccal mucosa ranging from the gingival buccal sulcus of maxilla to left hyomandibular furrow of mandible, and right tongue mucosa (Fig. 3).
Intraoperative view of three individual defects involved left half tongue, left buccal mucosa, and right tongue mucosa after the radical cancer ablation.
pone.0106326.g003.jpg
PMC4152256_01_pone.0106326.g003.jpg
pone-0106326-g003
Table 1) presented with left tongue cancer (T3N0M0), left buccal cancer (T2N0M0) and extensive mucosa leukoplakia on right tongue (Fig. 1 and 2) underwent a radical ablation of all oral lesions and left functional neck dissection. The resulting defects involved left half tongue, left buccal mucosa ranging from the gingival buccal sulcus of maxilla to left hyomandibular furrow of mandible, and right tongue mucosa (Fig. 3).
Intraoperative view after elevation of the tripaddled free ALT musculocutaneous flap.
pone.0106326.g004.jpg
PMC4152256_01_pone.0106326.g004.jpg
pone-0106326-g004
One-staged reconstruction by tripaddled free ALT musculocutaneous flap was performed on the left thigh (Fig. 4).
Intraoperative view of three separately skin paddles covering left buccal, left tongue, as well as right tongue mucosa defect respectively.. Vascular anastomosis was made between the artery of the flap and the left superior thyroid artery and between the veins of the flap and the external jugular vein as well as a branch of internal jugular vein.
pone.0106326.g005.jpg
PMC4152256_01_pone.0106326.g005.jpg
pone-0106326-g005
The distal skin paddle (6x8 cm2) was used to cover the left buccal defect, the middle one (5x7 cm2) for left half-tongue defect, and the proximal paddle (3x5 cm2) for right tongue defect (Fig. 5).
Appearance 2 months after operation with complete flap survival.
pone.0106326.g006.jpg
PMC4152256_01_pone.0106326.g006.jpg
pone-0106326-g006
Three skin paddles were all survival, and no recurrence occurred during 12-month follow-up (Fig. 6).
PMC4152256_02
Preoperative view of a recurrent hypopharyngeal cancer invaded the anterior neck skin.
pone.0106326.g007.jpg
PMC4152256_02_pone.0106326.g007.jpg
pone-0106326-g007
A 56-year-old male patient (case number 4 in Table 1) presented with a local recurrent hypopharyngeal cancer that invaded the esophagus and anterior neck skin (Fig. 7).
Intraoperative view of the resulting defects involved a part of esophagus and anterior neck skin after a radical salvage surgery including pharyngoesophagus, anterior neck skin and bilateral neck dissection.
pone.0106326.g008.jpg
PMC4152256_02_pone.0106326.g008.jpg
pone-0106326-g008
The resulting defects involved a part of circumferential esophagus and anterior neck skin (Fig. 8).
Intraoperative view after harvest of bipaddled free ALT fasciocutaneous flap.
pone.0106326.g009.jpg
PMC4152256_02_pone.0106326.g009.jpg
pone-0106326-g009
A bipaddled ALT fasciocutaneous flap was harvested (Fig. 9).
Intraoperative view of two separately skin paddles reconstructing neoesophagus and anterior neck skin respectively.. The distal paddle with two separately perforators was tubularized by itself to form a neoesophagus.
pone.0106326.g010.jpg
PMC4152256_02_pone.0106326.g010.jpg
pone-0106326-g010
The distal paddle (7x12 cm2) was tubularized by itself to form a neoesophagus, while the proximal paddle (7x8 cm2) for the defect of anterior neck skin, which also could monitor the inner free flap (Fig. 10).
Appearance 14 days after operation with complete flap survival.
pone.0106326.g011.jpg
PMC4152256_02_pone.0106326.g011.jpg
pone-0106326-g011
The flap survived completely without any complications (Fig. 11).
PMC4152256_03
Preoperative view of trismus due to right buccal cancer and left OSF.. The preoperative month opening was severely limited.
pone.0106326.g012.jpg
PMC4152256_03_pone.0106326.g012.jpg
pone-0106326-g012
Table 1) was presented with the right buccal tumor and progressive trismus of about 6-month duration which was caused by severe OSF (Fig. 12). The patient underwent a radical surgery for right buccal cancer, a transversal release of left OSF tissue, and right functional neck dissection.
Intraoperative view of right full-thickness cheek defects and left buccal mucosa defect after the radical cancer surgery.
pone.0106326.g013.jpg
PMC4152256_03_pone.0106326.g013.jpg
pone-0106326-g013
After ablation, the bilateral buccal defects were noted, including a left buccal mucosa defect (3x4 cm2), and a right through-and-through cheek defects which involved the intraoral defect (6x8 cm2) and the outer skin defect (4x6 cm2) (Fig. 13).
Intraoperative view after harvest of a tripaddled free ALT musculocutaneous flap.
pone.0106326.g014.jpg
PMC4152256_03_pone.0106326.g014.jpg
pone-0106326-g014
A free ALT musculocutaneous flap with three independent skin paddles was harvested (Fig. 14).
Early postoperative view of two proximal chimeric paddles restoring right full-thickness cheek defects and the distal paddle restoring left buccal defect.. The postoperative month opening was obviously improved.
pone.0106326.g015.jpg
PMC4152256_03_pone.0106326.g015.jpg
pone-0106326-g015
All skin paddles of the ALT flap were survival, and the postoperative month opening of the patient was improved obviously (Fig. 15).