Bilateral small radial forearm flaps for the reconstruction of buccal mucosa after surgical release of submucosal fibrosis: A new, reliable approach

Oral submucous fibrosis is a collagen disorder affecting the submucosal lay er and often severely limiting mouth opening. Previous surgical treatments have been disappointing. This article introduces a new surgical approach: r econstructing the bilateral buccal mucosa with two small radial forearm fla ps. The surgical method includes the complete surgical release of fibrotic buccal mucosa and, if necessary, a bilateral coronoidectomy and temporalis muscle myotomy. From 1997 to 1999, 15 patients with moderate-to-severe tris mus received reconstructive surgery, for a total of 30 small radial forearm flaps after surgical release. The flap size was between 1.5 x 5 and 2.5 x 7 cm. All donor sites were directly closed, and all flaps survived complete ly, except for one with partial necrosis. Six flaps required minor revision s because of size redundancy. Two patients developed buccal cancer in the a rea of reconstruction. At an average of 12 months' follow-up, the inter-inc isal distance averaged 33 mm, an increase of 17 mm compared with the preope rative value. The donor-site morbidity was minimal, except in one heavy smo ker who developed dry gangrene of his fingertips. The use of two small free forearm flaps for buccal mucosa reconstruction allows more radical release of fibrotic tissue. Coronoidectomy and temporal muscle myotomy further con tribute to the effect of trismus release. The combined effects of this appr oach have consistently given good results. An aggressive approach toward su rgical treatment of this precancerous lesion also facilitates the detection of cancer at an early stage.