Neuromucosal prelaminated flaps for reconstruction of intraoral lining defects after radical tumor resection

To reconstruct intraoral lining defects after radical tumor resection by re innervated vascularized mucosa, eight distal radial forearm flaps and two f ibula flaps were prelaminated. Prelamination was performed by exposing th vascularized fascia, onto which the split distal end of a sural graft was fixed. The fascia and the sural n erve graft were covered by device-meshed mucosa or small full-thickness muc osa pieces. These structures again were covered by a Silastic sheet as larg e as the future flap, and the wound was closed by the elevated skin and sub cutaneous tissue. Coverage by a Silastic sheet enabled mucosal spreading on the fascia, and the final flaps were thin, mucus-producing, and larger tha n the originally inserted mucosa. The 10 neuromucosal prelaminated flaps were harvested together with the ins erted sural nerve graft after 8 to 10 weeks. During this time, the patient underwent radiotherapy and chemotherapy. Donor sites were closed directly b y the preserved skin and subcutaneous tissue. Intraoral defects were recons tructed successfully by eight neuromucosal prelaminated distal radial forea rm flaps and two neuromucosal prelaminated fibula flaps. The sural nerve gr afts, inserted between the fascia and the mucosa, were coaptated eight time s with the lingual nerve and two times with the inferior alveolar nerve. Intended reinnervation of the mucosa could already be proved clinically and histologically in the first two patients after 11 and 9 months. Preservati on of skin and subcutaneous tissue considerably lowered donor-site morbidit y. Neuromucosal prelamination enables reconstruction of intraoral lining defec ts by reinnervated mucus-producing tissue. Reconstruction of other mucosa-l ined structures by this method seems feasible. Avoidance of skin islands fo r reconstruction lowers donor-site morbidity.