A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects-a Solution During the Resource-Constrained Setting of COVID Crisis

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A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects-a Solution During the Resource-Constrained Setting of COVID Crisis


JournalIndian Journal of Surgical Oncology
Publication date – Sep – 2020
Authors – Shiv Rajan, Naseem Akhtar, Vijay Kumar, Sameer Gupta, Sanjeev Misra, Arun Chaturvedi, Puneet Prakash, and Tashbihul Azhar
KeywordsAndy Gump deformity, Anterior arch mandible, covid-19, Ethylene terephthalate, Free fibular osteomyocutaneous flap, Pectoralis major myocutaneous flap
Open access – Yes
SpecialityENT surgery, Maxillofacial and oral surgery, Plastic surgery, Surgical Education
World region South-eastern Asia
Country: India
Language – English
Submitted to the One Surgery Index on November 14, 2020 at 11:34 am
Abstract:

The current COVID 19 pandemic has a major impact on healthcare delivery globally. Oral cancer involving anterior arch of mandible is difficult to reconstruct and ideally, requires free fibular osteomyocutaneous flap. During this time of resource constraint situation, these free flaps are not a great choice, as it increases exposure of both patient and surgical team to the deadly virus. We are describing a novel method of reconstruction after resection of oral cancer involving anterior arch of mandible. In this new technique, we have reconstructed central arch defect by hanging bipaddle pectoralis major myocutaneous flap with orbicularis oris muscle using ethylene terephthalate suture. Operative time, early postoperative complications and early cosmetic and functional outcome were assessed. We have used this novel technique in eight patients of T4a oral cancer involving anterior arch of mandible and skin over chin. Mean operative time was 180 min. One patient had minor flap loss with surgical site infection (Clavien-Dindo grade I). In all patients, we were able to discharge all patients on eighth postoperative day. Cosmetic outcome and functional outcomes were mostly satisfactory. All patients were able to oppose their lips without any oral incompetence and drooling. Tongue mobility was good. There was no incidence of ‘Andy Gump deformity’. This is a feasible option for reconstructing anterior arch defect in resource- and time-limited setting of COVID 19 pandemic. This technique can also be used in comorbid conditions where it is not advisable to do very long surgery.

OSI Number – 20762
PMID – 33013103

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