PMC4996063_01
Preoperative photograph of Case 1 showing right lower gingival cancer (A, B), intraoperative view of a right through-and-through buccal defect after the tumor ablation, and reinforcement of the mandible using a reconstruction plate (C).
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A reconstruction plate was used to reinforce the strength of the mandible (Figure 1).
At a follow-up of 2 years and 11 months in Case 1, there are no reconstruction plate exposures or trismus (A), except bulky flap (B), and the grafted donor site is unobtrusive (C).
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After 2 years and 11 months of follow-up, the flap has a bulky appearance but there is no exposure of the reconstruction plate or trismus, and the grafted donor site is unobtrusive (Figure 2).
PMC4996063_02
Clinical photograph of Case 2 showing flaccid paralysis with muscle atrophy in both the lower extremities.
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A 51-year-old man with atrophy of the muscles in both the lower extremities (Figure 3) presented with a cT4aN0M0 left buccal squamous cell carcinoma (35 x 23 x 20 mm) with skin invasion.
Intraoperative view of the flap harvesting for Case 2. Medial retraction of the rectus femoris muscle revealed atrophy and pale, yellowish, fat-like color of the vastus lateralis muscle that was affected by poliomyelitis. The diameter of the perforators (black arrow) appeared normal.
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The skin island measured 20 x 10 cm and included two cutaneous perforators (Figure 4). The quadriceps muscle had a pale, yellowish, fat-like color (Figure 4), and the intermuscular septum was not clear.
Immediate post-operative view of Case 2 following reconstruction with an ALT-free flap.
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The flap became pink in color, and the capillary refill returned to a normal level (Figure 5).
At a follow-up of one month in Case 2, the patient was satisfied with the reconstructed cheek (A) without donor site complications (B), and he could walk well with calipers and crutches (C).
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The muscle power in the right lower limb remained at Grade 0 and he could walk well with calipers and crutches (Figure 6).
Histopathological examination of a vastus lateralis muscle specimen from Case 2's paralytic lower limb revealed denervation muscle fiber atrophy with striation loss and collagen fiber accumulation (H&E 200x) (A). Histological sections of paralytic thigh skin showed the presence of chronic perivascular inflammatory cell infiltration and fibrosis. (H&E 100x) (B). H&E: haematoxylin and eosin.
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As expected, the evaluation of the vastus lateralis muscle revealed degeneration and fibrosis (Figure 7).