Comparison of the reconstruction of through-and-through cheek defects involving the labial commissure following tumor resection using four types of local and pedicle flaps

BACKGROUND: The reconstruction of through-and-through cheek defects involving the labial commissure following cancer ablation is a surgical challenge. METHODS: This study evaluated 35 patients with buccal squamous cell carcinoma (SCC) involving the labial commissure who underwent Abbe–Estlander (A-EF), folded extended supraclavicular fasciocutaneous island (SFIF), folded pectoralis major muscle (PMMF), or folded extended vertical lower trapezius island myocutaneous (TIMF) flap reconstruction of through-and-through cheek defects involving the labial commissure following radical resection. RESULTS: The A-EF and SFIF groups differed significantly (P < 0.05) from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment. The inner PMMF (median 6.3 × 4.5) and TIMF (median 9.8 × 6.7) skin paddle dimensions were larger than those of the A-EF (median 1.8 × 2.2) and SFIF (median 5.5 × 4.3) groups (P < 0.05). The outer PMMF (median 6.3 × 6.6) and TIMF (median 9.8 × 13.2) dimensions were larger than those of the A-EF (median 1.8 × 3.8) and SFIF (median 5.5 × 4.6) groups (P < 0.05). The esthetic results, orbicularis oris function, and speech function were significantly (P < 0.05) better in the A-EF group than in the SFIF, PMMF, and TIMF groups. The patients were followed for 6–38 months (median 26.8, 25.0, 22.1, and 20.8 months in the A-EF, SFIF, PMMF, and TIMF groups, respectively). At the final follow-up, 4 (80.0%) patients in the A-EF, 7 (87.5%) in the SFIF, 5 (55.6%) in the PMMF, and 5 (38.4%) in the TIMF groups were alive with no disease; 1 (20.0%), 1 (22.2%), 2 (22.2%), and 4 (30.8%) patients, respectively, were alive with disease; and 2 (22.2%) patients in the PMMF and 4 (30.8%) in the TIMF group had died of local recurrence or distant metastases at between 9 and 38 months. There was a significant survival difference in the A-EF and SFIF groups compared with the PMMF and TIMF groups (P < 0.05). CONCLUSIONS: The A-EF is suitable for reconstructing defects of clinical stage II disease; the SFIF for clinical stage II or III disease; the PMMF for clinical stage III or IV; and the TIMF for clinical stage rCS III or rCS IV disease.