European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
The delayed mouth-opening technique: a staged inset strategy to prevent distal necrosis in perioral free flap reconstruction.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhang Weidong, Song Shijie, Guo Kai, He Xiang, Tian Chenyang, Hu Dahai, Wang Yunchuan
Аннотация
PURPOSE: Severe perioral scarring from thermal injuries causes profound functional deficits. Circumferential free flap reconstruction risks distal ischemia upon acute oral aperture creation. This study evaluates a novel staged inset protocol using pre-expanded internal mammary artery perforator (IMAP) flaps to mitigate distal necrosis risk.
METHODS: A retrospective case series reviewed 12 patients with severe perioral scar contractures who underwent tissue expansion (Stage 1), scar excision and flap transfer with temporary 1- to 2-cm microstoma creation (Stage 2), and delayed definitive commissure division after 2 to 4 weeks (Stage 3). Outcomes included interincisal distance, dietary status, oral competence, patient satisfaction (Visual Analog Scale, VAS), and scar quality (Vancouver Scar Scale, VSS).
RESULTS: All primary facial flaps survived, with no distal necrosis. One primary facial flap required early re-exploration for venous thrombosis but was successfully salvaged. The mean interincisal distance improved from 15 mm preoperatively to 40 mm at a mean follow-up of 11.8 months. Preoperative drooling (n = 3) and dietary restrictions to liquids/semi-liquids (n = 3) were completely resolved. The mean VAS score was 8.3 ± 0.8, and VSS scores ranged from 2 to 4.
CONCLUSION: The delayed mouth-opening protocol achieved complete flap survival, objective functional restoration, and favorable aesthetic outcomes, offering a highly reliable strategy to prevent distal necrosis in severe perioral reconstruction.
METHODS: A retrospective case series reviewed 12 patients with severe perioral scar contractures who underwent tissue expansion (Stage 1), scar excision and flap transfer with temporary 1- to 2-cm microstoma creation (Stage 2), and delayed definitive commissure division after 2 to 4 weeks (Stage 3). Outcomes included interincisal distance, dietary status, oral competence, patient satisfaction (Visual Analog Scale, VAS), and scar quality (Vancouver Scar Scale, VSS).
RESULTS: All primary facial flaps survived, with no distal necrosis. One primary facial flap required early re-exploration for venous thrombosis but was successfully salvaged. The mean interincisal distance improved from 15 mm preoperatively to 40 mm at a mean follow-up of 11.8 months. Preoperative drooling (n = 3) and dietary restrictions to liquids/semi-liquids (n = 3) were completely resolved. The mean VAS score was 8.3 ± 0.8, and VSS scores ranged from 2 to 4.
CONCLUSION: The delayed mouth-opening protocol achieved complete flap survival, objective functional restoration, and favorable aesthetic outcomes, offering a highly reliable strategy to prevent distal necrosis in severe perioral reconstruction.