Algorithm for the treatment of oral and peri-oral defects through local flaps

Purpose: Local flaps are currently considered the main reconstructive option for medium-size oral and peri-oral defects; however, their indications are sometimes challenging to select. The aim of this study was to critically analyse their selection and to propose a therapeutic algorithm. Materials and methods: We performed a search on PubMed regarding the medium-size oral and peri-oral defects reconstruction, and we collected data on the aetiology, the location of the defect, the type of flap used and postoperative complications. The final proposed treatment algorithm was the product of this analysis. Results: We found 111 articles and 2504 flaps (236 buccinator flaps, 60 masseter flaps, 466 facial artery myomucosal flaps, 285 tongue flaps, 95 palatal flap, 525 buccal fat pad flaps and 835 local lip flaps). The most frequent defect localizations included floor of mouth (203 flaps), cheek (242 flaps), anterior hard palate (418 flaps) and upper and lower lip (274 and 559 flaps). Partial flap necrosis and dehiscence occurred in 3% of cases whereas total necrosis in 1%. Conclusions: Local flaps are a good option for oral and perioral defect reconstruction. An appropriate choice of the flap to be used based on the location of the defect is essential for a correct reconstruction.