Background: Reconstructing extensive composite defects remains a significant challenge, as it requires a flap incorporating both bone and a substantial amount of soft tissue. This study introduces the chimeric thoracodorsal artery flap with the scapula and latissimus dorsi (cTDAF-SLD) as a viable and comprehensive option for reconstructing large oromandibular defects. Methods: Twenty-nine patients with mandibular-invading oral cancer underwent radical tumor resection, followed by oromandibular reconstruction using either a chimeric thoracodorsal artery flap with the scapula and latissimus dorsi (cTDAF-SLD, n=18) or a simultaneous combination of a fibular flap and an anterolateral thigh (ALT) flap (SCFAF, n=11). Perioperative variables were recorded and functional and aesthetic outcomes were assessed using the Visual Analogue Scale (VAS), the University of Washington Quality of Life (UW-QOL) questionnaire, and the water swallow test. Results: The cTDAF-SLD group exhibited significantly lower operation time, blood loss, hospital stay duration, drainage volume, and hospital costs compared with the SCFAF group ( P <0.05). No significant differences were observed between the 2 groups in terms of functional and aesthetic outcomes. However, the incidence of complications at both the recipient and donor sites was significantly higher in the SCFAF group than in the chimeric TDAF group ( P <0.05). Conclusions: The chimeric TDAF with the scapula is a reliable option for reconstructing extensive oromandibular defects, offering comparable functional and aesthetic outcomes to simultaneous double free flaps while reducing complications.
Tan et al. (Wed,) studied this question.