The “Flap Suture Anchoring” Technique for Safe Oral Floor Reconstruction With Preservation of Alveolar Process

Flaps-based microsurgery is routinely applied to reconstruct oral floor defects caused by oncologic resection. To prevent orocutaneous fistulae, flaps are frequently sutured with buccal vestibule mucosa after sacrificing the alveolar process. The patients suffered denture loss and irreversible structural damage. For reliable oral floor reconstruction with preservation of alveolar process, the authors introduced the flap "suture anchoring" technique. Oral floor, hemiglossal-oral floor, and tongue base-parapharyngeal wall-oral floor defects were included in this study. The flap anchoring technique involves structural oral floor reconstruction with a chimeric anterolateral thigh-free flap or radial forearm flap with adipofascial tissue extension. The dead space in oral floor is filled with vastus lateralis muscle or adipofascial tissue, then holes are drilled on the alveolar bone among tooth root, beneath the attached gingiva. Skin paddle is sutured with 4-0 sutures through the alveolar holes thus anchored to the mandible. By applying this technique, there was no wound infection or orocutaneous fistulae in all patients postoperatively, even experienced postoperative radiotherapy. In addition, a soft and natural jaw-tongue furrow could be formed to allow the free movement of tongue. Taken together, the flap anchoring technique offers a safe and reliable approach to recover oral function and preservation of occlusion. Address correspondence and reprint requests to Wei Wu, MD, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China; E-mail: wuweidds@126.com Received 14 January, 2018 Accepted 9 February, 2018 This work was supported by the National Natural Science Foundation of China (grant numbers 31370997 and 81422008); the National High-tech R&D Program of China, and 863 Program (grant number 2015AA020920). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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