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The goal of this study is to retrospectively compare different types of free flaps to determine the most suitable free flap for functional reconstruction in oral squamous cell carcinoma patients following tumor resection. The main questions it aims to answer are:
Do the clinical characteristics of the thoracodorsal artery perforator flap differ from those of other types of flaps? Does the thoracodorsal artery perforator flap result in better clinical outcomes compared to other types of flaps? After reconstruction with the thoracodorsal artery perforator flap, do patients have better quality of life, speech function and scar healing compared to other types of flaps? Investigators will retrospectively compare the thoracodorsal artery perforator flap with other types of flaps (such as the anterolateral thigh flap, forearm flap, latissimus dorsi flap and fibula flap) to explore the most suitable free flap for facial defect reconstruction in oral squamous cell carcinoma patients.
Participants are oral squamous cell carcinoma patients who previously underwent facial defect reconstruction with different types of flaps. Participants have completed relevant questionnaires at 1, 3, 6 and 12 months post-surgery. The data will be scored and assessed by the investigators.
Oral squamous cell carcinoma (OSCC) severely impacts patients's quality of life (QoL). The combined treatment approach of surgery, radiation and chemotherapy can lead to oral function impairments, including swallowing and speech difficulties. Postoperatively, patients may also experience physical, emotional and functional sequelae, resulting in a significant decline in their QoL.
Functional maxillofacial defect repair has become a mainstream approach in surgical reconstruction. The thoracodorsal artery perforator (TDAP) flap is increasingly favored by oral and maxillofacial surgeons due to its advantages of fewer complications, favorable tissue characteristics and easy access to the latissimus dorsi nerve, making it the preferred option for maxillofacial defect reconstruction.
Postoperative QoL has become an important indicator for evaluating the prognosis of OSCC. In successful cases of OSCC surgery, patients may still experience a decline in QoL due to postoperative complications, oral function impairments and aesthetic issues, leading to a suicide rate much higher than that of other cancer patients. Compared to traditional free flaps, the TDAP flap has less conspicuous donor site scarring, which is hidden under the posterior axillary fold, thus offering significant advantages in aesthetics. Additionally, the motor nerve of the TDAP flap helps achieve functional reconstruction of the maxillofacial area, improving the postoperative QoL for OSCC patients.
In this retrospective study, the investigators will collect clinical data from 217 OSCC patients who underwent different free flap reconstructions at the Oral and Maxillofacial Surgery Department of Sun Yat-sen Memorial Hospital from January 2020 to December 2023. The investigators will assess the QoL, speech ability and scarring of patients using the Washington Quality of Life Scale, Speech Disorder Index Scale and Vancouver Scar Scale. The goal is to evaluate the repair and reconstruction outcomes of the TDAP flap in OSCC patients and to identify the most suitable flap choice for OSCC patients at this stage.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Anterolateral thigh flap group | Oral squamous cell carcinoma patients received the reconstruction with anterolateral thigh flaps after tumor resection |
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| Forearm flap group | Oral squamous cell carcinoma patients received the reconstruction with forearm flaps after tumor resection |
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| Latissimus dorsi flap group | Oral squamous cell carcinoma patients received the reconstruction with latissimus dorsi flaps after tumor resection |
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| Fibula flap group | Oral squamous cell carcinoma patients received the reconstruction with Fibula flaps after tumor resection |
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| Thoracodorsal artery perforator flap group | Oral squamous cell carcinoma patients received the reconstruction with Thoracodorsal artery perforator flaps after tumor resection |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracodorsal artery perforator flap reconstruction surgery | Procedure | Oral squamous cell carcinoma patients underwent reconstruction with thoracodorsal artery perforator (TDAP) flaps following tumor resection. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Quality of Life | The investigators applied the University of Washington Quality of Life (UW-QOL) questionnaire to evaluate the participants' appearance, functional outcomes and emotional well-being. This included scores for pain, appearance, activity, comfort, swallowing, chewing, speech, shoulder function, taste, saliva, emotion, anxiety and the overall total score. According to the UW-QOL version 4 questionnaire, each domain is scored on a scale from 0 to 100, with higher scores indicating a better quality of life. | Postoperative at 1, 3, 6, and 12 months |
| Postoperative Speech Function | The investigators evaluated postoperative speech function using the 30-item Speech Handicap Index (SPI) questionnaire. This questionnaire employs a 5-point Likert scale with the following response categories: "never" (0 points), "almost never" (1 point), "sometimes" (2 points), "almost always" (3 points), and "always" (4 points). The total SPI score ranges from 0 to 120 and includes two subscales: psychosocial function and speech function, each consisting of 14 items. Lower scores indicate better speech function. | Postoperative at 1, 3, 6, and 12 months |
| Scar Assessment | The investigators applied the Vancouver Scar Scale (VSS) questionnaire to evaluate the participants' scars at the donor site. This included scores for the pigmentation (score from 0-3), thickness (score from 0-3), blood supply (score from 0-5) and texture (score from 0-3) of the scar at donor site. According to the VSS questionnaire, a lower score indicates a better outcome with the similar appearance like normal, however a higher score indicates an abnormal appearance and contracture. | Postoperative at 1, 3, 6, and 12 months |
| Swallowing Function Assessment | The investigators applied the NIH Swallowing Safety Scale (NIH-SSS) questionnaire to evaluate the participants' swallowing function. The total score of NIH-SSS ranges from 0 to 10 points, with each score reflecting a different level of swallowing safety. A score of 0 indicates completely safe swallowing with no signs of aspiration or difficulty, while a score of 10 represents the most severe aspiration or swallowing impairment, potentially requiring urgent intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Flap Complication Incidence | The rate at which the blood supply to the flap suddenly interrupts or significantly decreases postoperatively, leading to ischemia or necrosis of the flap. | Postoperative at 1, 3, 6, and 12 months |
| Flap Failure Incidence |
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Inclusion Criteria:
Exclusion Criteria:
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Any patient with oral squamous cell carcinoma undergoing reconstruction with thoracodorsal artery perforator flap, anterolateral thigh flap, forearm flap, latissimus dorsi flap, or fibula flap at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2020 to June 2023 will be included. Descriptive statistics will be generated for all outcome measures. Statistical analysis will be conducted using SPSS software version 23.0.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Youyuan Wang, MD, Ph.D | Contact | +8613631333312 | Wangyy78@mail.sysu.edu.cn | |
| Liushan Ou, MD | Contact | +8681332587 | sys_iit@163.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sun Yat-sen Memorial Hospital, Sun Yat-sen Univerity | Guangzhou | Guangdong | 510120 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38147089 | Background | Min F, Qiu P, Zhu X, Zhou B, Lin Z, Pan C, Wang Y. Modified submandibular mandibulotomy approach versus lip-splitting approach in tongue cancer surgery: a retrospective paired-cohort study. Clin Oral Investig. 2023 Dec 26;28(1):32. doi: 10.1007/s00784-023-05395-3. | |
| 32289869 | Background | Zhou B, Liao J, Zhu C, Yuan K, Liu Z, Lin Z, Huang Z, Chen W, Li J, Wang Y. Full cheek defect reconstruction using ALTF versus RFF: Comparison of quality of life, clinical results, and donor site morbidity. Oral Dis. 2020 Sep;26(6):1157-1164. doi: 10.1111/odi.13354. Epub 2020 May 4. |
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To protect participants' privacy, the data may include sensitive information such as personal identification or health status. If IPD is needed, please contact the project investigator.
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| Forearm flaps reconstruction surgery | Procedure | Oral squamous cell carcinoma patients received the reconstruction with forearm flaps after tumor resection |
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| Anterolateral thigh flap reconstruction surgery | Procedure | Oral squamous cell carcinoma patients received the reconstruction with anterolateral thigh flaps after tumor resection |
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| Fibula flap reconstruction surgery | Procedure | Oral squamous cell carcinoma patients received the reconstruction with fibula flaps after tumor resection |
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| Forearm flap reconstruction surgery | Procedure | Oral squamous cell carcinoma patients received the reconstruction with forearm flaps after tumor resection |
|
| Postoperative at 1, 3, 6, and 12 months |
The rate at which the flap fails to survive and heal due to insufficient blood supply, infection, technical issues, or other complications, resulting in partial or complete necrosis of the flap.
| Postoperative at 1, 3, 6, and 12 months |
| Postoperative Complications | Includes complications at the recipient site (hematoma, infection, wound dehiscence, and fistula), complications at the donor site (hematoma, infection, and wound dehiscence), and lower limb venous thrombosis. | Postoperative at 1, 3, 6, and 12 months |
| Patient Bed Rest Duration | The time a patient spends completely resting in bed postoperatively, during which the patient is unable to move independently or can only perform necessary bedside activities with the assistance of caregivers. | Postoperative at 1 months |
| Flap Pedicle Vein Diameter | The investigators used a Micro-Vessel Caliper to measure the cross-sectional diameter of the vein in the flap pedicle during flap-harvesting surgery. | Postoperative at 1 day |
| Flap Pedicle Artery Diameter | The investigators used a Micro-Vessel Caliper to measure the cross-sectional diameter of the artery in the flap pedicle during flap-harvesting surgery. | Postoperative at 1 day |
| Flap Pedicle Vessel Separation Length | The maximum distance that can be separated between the point where the flap's blood supply vessel (artery or vein) enters the flap and the furthest point of its branching. | Postoperative at 1 day |
| Flap Surgical Operation Time | The total time spent on the flap procedure, including the time for designing the flap, harvesting the flap, shaping the flap, and placing and securing the flap. | Postoperative at 1 day |
| 41350686 | Derived | Wu F, Xia X, Zhu C, Fu M, Zhu X, Wang J, Lan T, Wang Y. Functional tongue reconstruction using innervated TDAP versus ALT free flaps: a retrospective paired-cohort study. Head Face Med. 2025 Dec 5;22(1):3. doi: 10.1186/s13005-025-00572-z. |
| ID | Term |
|---|---|
| D000077195 | Squamous Cell Carcinoma of Head and Neck |
| ID | Term |
|---|---|
| D002294 | Carcinoma, Squamous Cell |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006258 | Head and Neck Neoplasms |
| D009371 | Neoplasms by Site |
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