[Clinical efficacy of composite transplantation of fascia lata-anterolateral thigh flap in repairing complex defects after radical tumor resection in maxillofacial region].

Objective: To investigate the clinical efficacy of composite transplantation of fascia lata-anterolateral thigh flap for repairing complex defects after radical tumor resection in maxillofacial region. Methods: This study was a retrospective observational study. From January 2023 to January 2024, 12 patients (7 males and 5 females, aged 42 to 60 years) meeting the inclusion criteria with complex defects after radical tumor resection in maxillofacial region were treated at the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University. After radical tumor resection, the sizes were 6.0 cm×4.0 cm to 11.0 cm×10.0 cm for skin and soft tissue defects and 4.0 cm×3.0 cm to 11.0 cm×5.0 cm for buccal mucosa-zygomatic arch defects. The anterolateral thigh flap with area ranging from 7.0 cm×5.0 cm to 12.0 cm×11.0 cm was first designed and harvested, followed by the underlying fascia lata (ranging from 4.0 cm×3.0 cm to 11.0 cm×5.0 cm). Then, the fascia lata was used first to reconstruct the oral lining, and the anterolateral thigh flap was subsequently employed to repair the residual skin and soft tissue defects. Postoperatively, the survival of the patient's flap was observed, the epithelialization time of the fascia lata used as lining was recorded, and wound healing at the donor and recipient sites was monitored, along with whether complications such as vascular crisis, oral fistula, or infection were present at the recipient site. During follow-up, the epithelialization of the fascia lata as a lining was observed, the mouth opening degree of the patient was measured, the occlusal function was evaluated, and the facial appearance and scar condition in donor site were observed. Results: Postoperatively, all flaps of patients survived successfully, with the fascia lata used as a lining achieving complete epithelialization within 8-10 days. Only one patient with maxillary sinus squamous cell carcinoma experienced delayed wound healing at the flap margin, which was resolved after dressing changes; the recipient site wounds in the remaining patients healed well. All the donor site healed well. No vascular crisis, oral fistula, infection, or other complications occurred at the recipient sites. During 3 months of follow-up, the oral mucosa had covered the surface of the fascia lata; the vertical mouth opening was 3 transverse fingers in 9 cases, 2.5 transverse fingers in 1 case, 2 transverse fingers in 1 case, and 1.5 transverse fingers in 1 case, the horizontal mouth opening was 3-5 cm; chewing and swallowing functions were normal. All patients exhibited facial symmetry with the surgical area being full, and only linear scars were left in the donor sites. Conclusions: The composite transplantation of fascia lata-anterolateral thigh flap demonstrates excellent efficacy in repairing complex defects after radical tumor resection in maxillofacial area. Through staged reconstruction of both the oral barrier and soft tissue defects, this approach significantly reduces the risk of postoperative complications while achieving functional recovery and aesthetic reconstruction.