The radial forearm free flap (RFFF) is commonly used in the reconstruction of oral cancer patients. Traditional RFFF (TRFFF) techniques, which often require a secondary donor site to repair the forearm defect, may result in a scar extending to the dorsal hand. This can lead to significant functional and aesthetic concerns in the forearm. We designed a modified RFFF (MRFFF) that incorporates a glasses-shaped flap and features deep venous drainage. To evaluate its effectiveness we conducted a retrospective chart review of 105 patients with oral squamous cell carcinoma who underwent reconstructive surgery between 2018 and 2022. These patients were treated either with a TRFFF (n = 60) or the newly developed MRFFF (n = 45). Our inclusion criteria, guided by preliminary surgical experience prior to initiating the study, stipulated that single oral defects should be no larger than 6 × 6 cm2, and adjacent double defects no larger than 3 × 6 cm2. Flap size, pedicle length, harvesting duration, and anastomosis during the surgical procedure were compared between the two techniques. Preoperative and postoperative oral function, recurrence, mortality, and dorsal scarring were recorded. One-week, one-month, and six-month postoperative subjective aesthetics assessments, and self-reported postoperative donor hand function, were measured using the Michigan hand questionnaire (MHQ). There were no significant differences between the groups in terms of flap size, pedicle length, harvesting time, anastomosis time, postoperative oral function, recurrence, and mortality. However, patients with a MRFFF did not require a second donor graft site and did not have scars extending to the dorsal forearm. They also had significantly improved postoperative aesthetic outcomes (1 week: 70.6%, 1 month: 62.2%) and donor hand function (1 week: 54.6%, 1 month: 40.4%) compared with the TRFFF group (p < 0.001). The MRFFF eliminates the need for secondary donor sites and improves primary donor site outcomes. It is versatile and can be employed for either single or composite oral defects. Through extensive case studies, we have defined its specific scope: it is suitable for single defects measuring no more than 6 × 6 cm2, or for composite defects no larger than 3 × 6 cm2. Furthermore, it does not compromise the functional recovery of the recipient site, and should be widely adopted for all qualifying patients.

To investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection.
Between December 2012 and December 2016，18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years (range, 43-62 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan. The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and 10 cm×8 cm. The donor site was sutured directly.
Eighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years (mean, 26.6 months). The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap.
Large scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.
总结游离股前外侧 Kiss 皮瓣修复巨大头皮恶性肿瘤术后缺损的疗效。.
2012 年 12 月—2016 年 12 月，收治巨大头皮恶性肿瘤患者 18 例。男 16 例，女 2 例；年龄 43～62 岁，平均 52.6 岁。鳞状细胞癌 17 例，隆突性纤维肉瘤 1 例。病程 3 个月～6 年，中位时间 22.1 个月。术中彻底切除肿瘤后，头皮软组织缺损范围为 15 cm×10 cm～17 cm×12 cm；2 例颅骨受累者切除全层颅骨后，缺损面积分别为 10 cm×8 cm、12 cm×10 cm。制备游离股前外侧 Kiss 皮瓣修复创面，皮瓣切取范围为 15 cm×6 cm～20 cm×8 cm；钛网修复颅骨缺损。供区直接拉拢缝合。.
术后皮瓣顺利成活，创面 Ⅰ 期愈合；供区切口均 Ⅰ 期愈合。1 例因局部复发侵犯颅内于术后 5 个月死亡，其余患者均无局部复发。患者均获随访，随访时间 6 个月～4 年，平均 26.6 个月。术后皮瓣外观较满意，随访期内无破溃发生。供区切口遗留线性瘢痕，未遗留明显功能障碍。.
游离股前外侧 Kiss 皮瓣可修复巨大头皮恶性肿瘤切除术后缺损，同时供区能直接拉拢缝合，避免因植皮产生第 2 供区。.

To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm.
Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured.
Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S 1 in 2 cases, S 2 in 6 cases, S 3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases.
The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
探讨采用背阔肌 Kiss 皮瓣修复上臂复合组织缺损及功能重建的临床疗效。.
2010 年 3 月—2016 年 11 月，采用带神经血管束的背阔肌 Kiss 皮瓣修复 12 例上臂复合组织缺损。其中男 8 例，女 4 例；年龄 21～50 岁，中位年龄 34 岁。致伤原因：机械损伤 4 例，交通事故伤 5 例，电击伤 2 例，上臂软组织恶性肿瘤 1 例。合并三角肌缺损 5 例，肱三头肌及肱肌损伤 4 例，三角肌、肱三头肌及肱肌不同程度损伤 3 例。创面范围 13 cm×7 cm～20 cm×8 cm。合并骨折伴骨外露 6 例，其中 1 例合并骨缺损。病程 3 h～6 个月。皮瓣切取范围为 10 cm×6 cm～15 cm×7 cm；供区创面直接缝合。.
12 例皮瓣全部成活，供、受区创面均Ⅰ期愈合。10 例患者获随访，随访时间 6～26个月，平均 14 个月。末次随访时，移植皮瓣成活良好、质地柔软，颜色接近周围正常皮肤，供区仅见线性瘢痕；肩关节外展活动度达 30～90°，肱三头肌肌力均在 4 级及以上；浅感觉与触觉部分恢复，S 1 2 例，S 2 6 例，S 3 2 例。采用中华医学会手外科学会上肢部分功能评定试用标准评定肩关节功能，获优 2 例，良 4 例，可 4 例。.
背阔肌 Kiss 皮瓣设计灵活，供区可直接拉拢缝合，带神经支配的背阔肌可重建上肢部分外展功能，修复上臂复合组织缺损可获良好疗效。.

OBJECTIVE: To investigate the clinical value of pedicled latissimus dorsi Kiss flap in repairing chest wall large skin defect after tumor operation.
METHODS: A retrospective analysis was made on the clinical data from 15 cases of chest wall tumors treated between December 2010 and December 2015. There were 2 males and 13 females with an average age of 51.8 years (range, 43-60 years); there were 11 cases of locally advanced breast cancer, 3 cases of fibrosarcoma in chest wall, and 1 case of chest wall radiation ulcer with a median disease duration of 24.1 months (range, 6 months to 8 years). The area of skin defects was 17 cm×12 cm to 20 cm×18 cm after primary tumor resection; the pedicled latissimus dorsi Kiss flap was designed to repair wounds. The flap was a two-lobed flap at a certain angle on the surface of latissimus dorsi based on the thoracodorsal artery, with a size of 17 cm×6 cm to 20 cm×9 cm for each lobe. The donor site was sutured directly.
RESULTS: Fourteen flaps survived with primary healing of wound; delayed healing was observed in 1 flap because of distal necrosis; and healing by first intention was obtained at the donor sites. The follow-up time was from 6 months to 3 years (mean, 21.6 months). The flap had good appearance with no bloated pedicle. The shoulder joint activities were normal. No local recurrence occurred, but distant metastasis in 2 cases. No obvious scar was found at donor sites.
CONCLUSIONS: The application of pedicled latissimus dorsi Kiss flap to repair chest wall skin defects after tumor resection has important clinical value, because of the advatages of simple operation, minor donor site damage and rapid postoperative recovery, especially for late stage cancer patients.
UNASSIGNED: 探讨带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的疗效。.
UNASSIGNED: 2010年12月-2015年12月，收治15例胸壁肿瘤患者。男2例，女13例；年龄43～60岁，平均51.8岁。局部晚期乳腺癌11例，胸壁皮肤纤维肉瘤3例，胸壁放射性溃疡1例。病程6个月～8年，中位时间24.1个月。术中切除原发灶后，胸壁皮肤软组织缺损范围达17 cm×12 cm～20 cm×18 cm；采取带蒂背阔肌Kiss皮瓣移位修复创面，A、B两瓣大小相等，单个皮瓣切取范围为17 cm×6 cm～20 cm×9 cm；供区直接拉拢缝合。.
UNASSIGNED: 术后14例皮瓣顺利成活，创面Ⅰ期愈合；1例皮瓣远端坏死，经换药后延期愈合。供区切口均Ⅰ期愈合。患者均获随访，随访时间6个月～3年，平均21.6个月。术后皮瓣外观良好，蒂部无臃肿，对肩关节活动无明显影响。肿瘤患者均无局部复发，2例乳腺癌患者发生远处转移。供区切口遗留线性瘢痕。.
UNASSIGNED: 应用带蒂背阔肌Kiss皮瓣修复胸壁皮肤软组织缺损，手术操作简便，供区损伤小，术后恢复快，为后续治疗争取了时间。.