Journal of Maxillofacial and Oral Surgery

, Volume 16, Issue 3, pp 292–299 | Cite as

Histological Changes in Nasolabial Cutaneous Flaps Employed in Intraoral Reconstruction

  • Lazaridou Maria
  • Dimitrakopoulos Ioannis
  • Vaxtsevanos Konstantinos
  • Iordanidis Fotis
  • Antoniades Konstantinos
Research Paper
  • 94 Downloads

Abstract

Introduction

Nasolabial cutaneous flaps have been routinely used to reconstruct intraoral defects. The purpose of this study was to study histological changes that may occur in the skin flap as a result of its exposure to a new environment.

Patients and Methods

Thirteen patients took part in this study. Fusiform tissue specimens were obtained from the intraoral cutaneous portion of the flap. Biopsy specimens were also taken from the skin of nasolabial region and from the buccal mucosa to serve as control. Thickness of stratum corneum, degree of inflammatory infiltration and number of skin appendages were evaluated. Periodic-acid Schiff (PAS) staining was also performed to identify the presence of hyphae.

Results

The characteristic features of the skin are almost always maintained, although the thickness of stratum corneum and the number of skin appendages are often significantly reduced. In two patients the inflammatory infiltration was intense and accompanied by elimination of skin appendages and stratum corneum. These flaps tend to mimic mucosa macroscopically. In four patients fibrosis was histologically demonstrated. These flaps resembled atrophic skin macroscopically. Hyphae could not be identified with PAS staining in this study. Koilocytes, which are indicative of HPV infection, were identified in two flap specimens.

Conclusions

Intraorally placed nasolabial flaps may undergo a variety of histological and macroscopical changes. In the majority of cases the intraoral cutaneous flap maintains skin features, except if it becomes heavily infiltrated with inflammatory cells. Inflammation occurs for unknown reasons and results in a mucosa-like microscopic and macroscopic appearance of the intraorally placed flap.

Keywords

Cutaneous flaps Mucosalization Koilocytes Intraoral reconstruction 

Notes

Funding

This study was not funded.

Compliance with Ethical Standards

Conflict of Interest

Lazaridou Maria, Dimitrakopoulos Ioannis, Vaxtsevanos Konstantinos, Iordanidis Fotis, Antoniades Konstantinos: declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Wei WI, Lam KH, Lau WF (1989) Fate of skin element of pectoralis major flap in intraoral reconstruction. Arch Otolaryngol Head Neck Surg 115(3):360–363CrossRefPubMedGoogle Scholar
  2. 2.
    Pinto FR, Kanda JL, Diniz MT, Santos CP, Zveibil DK (2009) Delayed histological changes in cutaneous portion of pectoralis major flaps employed in upper aero-digestive tract reconstruction. Eur Arch Otorhinolaryngol 266(4):553–558CrossRefPubMedGoogle Scholar
  3. 3.
    Shibahara T, Noma H, Takeda E, Hashimoto S (2000) Morphologic changes in forearm flaps of the oral cavity. J Oral Maxillofac Surg 58(5):495–499CrossRefPubMedGoogle Scholar
  4. 4.
    Sinclair A, Johnston E, Badran DH, Neilson M, Soutar DS, Robertson AG, McDonald SW (2004) Histological changes in radial forearm skin flaps in the oral cavity. Clin Anat 17(3):227–232CrossRefPubMedGoogle Scholar
  5. 5.
    Dellon AL, Tarpley TM, Chretien PB (1976) Histologic evaluation of intraoral skin grafts and pedicle flaps in humans. J Oral Surg 34(9):789–794PubMedGoogle Scholar
  6. 6.
    Beahm EK, Evans GR, Colome-Grimmer MI (1997) Histologic changes of intraoral free skin flaps. Am J Surg 174(5):492–494CrossRefPubMedGoogle Scholar
  7. 7.
    Khan AL, Cloke DJ, Hodgkinson PD, McLean NR, Soames JV (2001) Do intraoral radial forearm free flaps re-mucosalise and is Candida infection relevant? Br J Plast Surg 54(4):299–302CrossRefPubMedGoogle Scholar
  8. 8.
    Badran D, Soutar DS, Robertson AG, Reid O, Milne EW, McDonald SW, Scothorne RJ (1998) Behavior of radial forearm skin flaps transplanted into the oral cavity. Clin Anat 11(6):379–389CrossRefPubMedGoogle Scholar
  9. 9.
    Rubino C, Dessy LA, Farace F, Ena P, Mazzarello V (2002) Microscopic and immunohistochemical analysis of the skin changes of free forearm flaps in intraoral reconstruction. Ann Plast Surg 49(4):362–368CrossRefPubMedGoogle Scholar
  10. 10.
    Woolgar JA, Triantafyllou A (2009) Histological changes in intra-oral skin flaps. Head Neck Oncol 12(1):2CrossRefGoogle Scholar
  11. 11.
    Katou F, Motegi K, Tagami H, Shirai N, Echigo S, Nagura H (1999) Unique inflammatory features noted in intraorally transferred skin flaps: correlation with Candida albicans infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87(6):676–684CrossRefPubMedGoogle Scholar
  12. 12.
    Petruzzelli GJ, Johnson JT, Myers EN, Kline JM (1992) Histomorphometric analysis of intraoral split-thickness skin grafts. Head Neck 14(2):119–124CrossRefPubMedGoogle Scholar
  13. 13.
    McCullough M, Jaber M, Barrett AW, Bain L, Speight PM, Porter SR (2002) Oral yeast carriage correlates with presence of oral epithelial dysplasia. Oral Oncol 38(4):391–393CrossRefPubMedGoogle Scholar
  14. 14.
    Bergsmedh A, Szeles A, Henriksson M, Bratt A, Folkman MJ, Spetz AL, Holmgren L (2001) Horizontal transfer of oncogenes by uptake of apoptotic bodies. Proc Natl Acad Sci U S A 98(11):6407–6411CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Robinson C, Prime SS, Paterson IC, Guest PG, Eveson JW (2007) Expression of Ki-67 and p53 in cutaneous free flaps used to reconstruct soft tissue defects following resection of oral squamous cell carcinoma. Oral Oncol 43(3):263–271CrossRefGoogle Scholar
  16. 16.
    Wolff KD, Dienemann D, Hoffmeister B (1995) Intraoral defect coverage with muscle flaps. J Oral Maxillofac Surg 53(6):680–686CrossRefPubMedGoogle Scholar
  17. 17.
    Katou F, Shirai N, Kamakura S, Tagami H, Nagura H, Motegi K (2003) Differential expression of cornified cell envelope precursors in normal skin, intraorally transplanted skin and normal oral mucosa. Br J Dermatol 148(5):898–905CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2016

Authors and Affiliations

  • Lazaridou Maria
    • 1
    • 2
  • Dimitrakopoulos Ioannis
    • 1
  • Vaxtsevanos Konstantinos
    • 1
  • Iordanidis Fotis
    • 1
  • Antoniades Konstantinos
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Neapoli, ThessalonikiGreece

Personalised recommendations