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Ferri A, Perlangeli G, Zito F, Ferrari S, Bianchi B, Arcuri F, Poli T. Technical refinements of the scapular tip-free flap for mandibular reconstruction. Microsurgery 2024; 44:e31176. [PMID: 38553855 DOI: 10.1002/micr.31176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients. PATIENTS AND METHODS Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy. RESULTS The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients. CONCLUSION The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.
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Affiliation(s)
- Andrea Ferri
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Silvano Ferrari
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Francesco Arcuri
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Tito Poli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
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Dhoot A, Mackenzie A, Rehman U, Adebayo O, Neves S, Sohaib Sarwar M, Brennan PA. Use of scapular tip flaps in the reconstruction of head and neck defects: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:233-246. [PMID: 38431506 DOI: 10.1016/j.bjoms.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
Scapular tip flaps (STF) may be used as an alternative to traditional methods of reconstruction of head and neck cancer (HNC) defects. This study aimed to establish the success and complication rates for STF in HNC reconstruction. A literature search was conducted on PubMed, BMJ Journals, DARE, EMBASE databases and Cochrane (CENTRAL) register. (Registry CRD42023428012). A total of 23 studies fulfilled the inclusion criteria with 474 patients who underwent reconstructive procedures using the STF. 100% of STF used were free flaps (STFFs). The most common reason for reconstruction was following malignancy (81.4%, n = 386). The pooled success rates in all studies using scapular tip flaps in head and neck reconstruction was 99% (95% CI, 97 to 100, p = 1.00; I2 = 0). Pooled total complication rates were 38% (95% CI, 25 to 51, p < 0.01; I2 = 90%). 19.6% required return to theatre with only 1.5% being for repeat flap coverage. The STF demonstrated an overall success rate of 99%. This is higher than other documented success rates with mainstay flaps for HNC defect reconstruction. Complication and re-operation rates were also like recorded rates. This review demonstrates the advantage of STF as a safe and versatile reconstructive option for HNC related defects. Evaluation of the literature is limited by poor-quality studies and comparability bias.
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Affiliation(s)
- Amber Dhoot
- Final Year Medical Student, Imperial College London, London, United Kingdom.
| | - Alexandra Mackenzie
- Foundation Doctor, Department of Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Umar Rehman
- Core Surgical Trainee, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Oluwasemilore Adebayo
- Final Year Medical Student, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Salma Neves
- Final Year Medical Student, Imperial College London, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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3
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Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S. Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 2024; 169:107887. [PMID: 38160502 DOI: 10.1016/j.compbiomed.2023.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Katrina Zaraska
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Atabak Eghbal
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sophie McGregor
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Eitan Prisman
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sidney Fels
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
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4
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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5
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Shuck JW, Largo RD, Hanasono MM, Chang EI. Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1762. [PMID: 37893480 PMCID: PMC10608668 DOI: 10.3390/medicina59101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Reconstruction of the midface represents a challenge for reconstructive microsurgeons given the formidable task of restoring both aesthetics and functionality. In particular, preservation of proper globe positioning and maintaining normal vision are as important as restoring the proper projection of the midface and enabling a patient to speak and eat as normally as possible. The introduction of virtual surgical planning (VSP) and medical modeling has revolutionized bony reconstruction of the craniofacial skeleton; however, the overwhelming majority of studies have focused on mandibular reconstruction. Here, we introduce some novel advances in utilizing VSP for bony reconstruction of the midface. The present review aims (1) to provide a review of the literature on the use of VSP in midface reconstruction and (2) to provide some insights from the authors' early experience.
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Affiliation(s)
| | | | | | - Edward I. Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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6
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Agarwal M, Lobo R, Srinivasan A. Postoperative Imaging Appearances of the Paranasal Sinuses. Semin Roentgenol 2023; 58:248-260. [PMID: 37507167 DOI: 10.1053/j.ro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Froedtert and Medical College of Wisconsin, Milwaukee, WI.
| | - Remy Lobo
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
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7
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McCrary HC, Seim NB, Old MO. History, Innovation, Pearls, and Pitfalls in Complex Midface Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00067-1. [PMID: 37230926 DOI: 10.1016/j.otc.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Midface reconstruction in head and neck cancer or individuals with extensive trauma to the face has evolved significantly over the past few decades with the introduction of free flap reconstruction and virtual surgical planning enabling surgeons to obtain optimal cosmetic and functional outcomes. Traditional methods such as the use of obturators or local flaps still have a role in select situations, but complex defects have been replaced by the advent of microvascular free tissue transfer and virtual planning, which can commonly provide a single-stage reconstruction of the midface with excellent aesthetic and functional results. This article provides an overview of the history and evolution of midface reconstruction, a discussion of how to integrate virtual surgical planning into a surgical practice, an example of a complex midface reconstruction case, and pearls and pitfalls that have been experienced by an experienced reconstructive team.
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Affiliation(s)
- Hilary C McCrary
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Tran KL, Yang DH, Wang E, Ham JI, Wong A, Panchal M, Dial HS, Durham JS, Prisman E. Dental implantability of mandibular reconstructions: Comparing freehand surgery with virtual surgical planning. Oral Oncol 2023; 140:106396. [PMID: 37068411 DOI: 10.1016/j.oraloncology.2023.106396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Khanh Linh Tran
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - David H Yang
- Faculty of Dentistry, University of British Columbia, 2151, Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Edward Wang
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Jennifer Inseon Ham
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Angela Wong
- Faculty of Dentistry, University of British Columbia, 2151, Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Maharshi Panchal
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Harkaran Singh Dial
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - James Scott Durham
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Eitan Prisman
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Diamond Health Care Centre, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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10
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Tran KL, Kwon JY, Gui XY, Wang E, Yang D, Durham JS, Prisman E. Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design. Head Neck 2023; 45:115-125. [PMID: 36255135 DOI: 10.1002/hed.27214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap. METHODS An open-source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected. RESULTS Ten patients in the VSP cohort and 18 in the non-VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two-team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort. CONCLUSIONS Maxillary reconstruction planned with an in-house open-source VSP platform and accompanied simple guides can facilitate a two-team approach, reduce operative time, and improve structural accuracy. This open-source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.
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Affiliation(s)
- Khanh Linh Tran
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jae Young Kwon
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xi Yao Gui
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Wang
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Yang
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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The state of virtual surgical planning in maxillary Reconstruction: A systematic review. Oral Oncol 2022; 133:106058. [PMID: 35952582 DOI: 10.1016/j.oraloncology.2022.106058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022]
Abstract
Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of the technology over traditional free hand surgery cite benefits including improved intraoperative efficiencies and postoperative outcomes that have been demonstrated during mandibular reconstruction. More recently, VSP for maxillary and mid facial reconstruction, generally considered more complex than their mandibular counterparts, have been applied with the hopes of similar benefits. However, our literature search revealed no large-scale randomized control trial substantiating these benefits. As such, the aim of this review was to synthesize the existing research on utilization of VSP in the context of maxillary reconstruction. Three databases were systematically searched for articles pertaining to maxillary reconstruction for oncologic, traumatic, or osteoradionecrosis indications. Four hundred and fourteen unique articles were reviewed by two independent reviewers ultimately revealing sixteen studies appropriate for qualitative synthesis including 142 patients. Results of our studies reveal the extreme heterogenicity of application of this technology under the label of virtual surgical planning. Outcome reporting methods were grossly inconsistent amongst all the articles resulting in inability to appropriately synthesize data quantitatively for a meta-analysis. Overall, there was no standard of reporting outcomes of maxillary reconstruction, and no randomized trials comparing virtual surgical planning versus freehand surgery and therefore there is insufficient data to objectively prove purported benefits. To facilitate future comparative studies, a minimal standard of reporting for maxillary VSP is presented and the need for a randomized control trial is highlighted.
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12
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Tran KL, Mong ML, Durham JS, Prisman E. Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education. J Clin Med 2022; 11:jcm11185306. [PMID: 36142953 PMCID: PMC9501640 DOI: 10.3390/jcm11185306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates. Ten Otolaryngology residents each performed two ex vivo mandibular reconstructions, first using a PSRP followed by a manually contoured plate. Reconstruction time, CT scans, and accuracy measurements were collected. Paired Student’s t-test was performed. There was a significant difference between reconstructions with PSRP and manually contoured plates in: plate-mandible distance (0.39 ± 0.21 vs. 0.75 ± 0.31 mm, p = 0.0128), inter-fibular segment gap (0.90 ± 0.32 vs. 2.24 ± 1.03 mm, p = 0.0095), mandible-fibula gap (1.02 ± 0.39 vs. 2.87 ± 2.38 mm, p = 0.0260), average reconstruction deviation (1.11 ± 0.32 vs. 1.67 ± 0.47 mm, p = 0.0228), mandibular angle width difference (5.13 ± 4.32 vs. 11.79 ± 4.27 mm, p = 0.0221), and reconstruction time (16.67 ± 4.18 vs. 33.78 ± 8.45 min, p = 0.0006). Lower plate-mandible distance has been demonstrated to correlate with decreased plate extrusion rates. Similarly, improved bony apposition promotes bony union. PSRP appears to provide a more accurate scaffold to guide the surgeons in assembling donor bone segments, which could potentially improve patient outcome and reduce surgical time. Additionally, in-house PSRP can serve as a low-cost surgical simulation tool for resident education.
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13
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Liu AQ, Deane EC, Heffernan A, Ji Y, Durham JS, Prisman E. Patient-reported outcomes and morbidity after head and neck reconstructions: An evaluation of fibular and scapular free flaps. Oral Oncol 2022; 132:106019. [PMID: 35841704 DOI: 10.1016/j.oraloncology.2022.106019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fibular (FFF) and scapular free flaps (SFF) are versatile tissue transfers for head and neck reconstruction. However, their relative morbidity has been sparsely studied. The primary goal of this study was to evaluate the morbidity and patient-reported outcome measures of these two reconstructive options. MATERIALS AND METHODS Case series of patients from 2017 to 2020 who underwent a FFF or SFF for head and neck ablation. Demographic and surgical outcome measures, such as Charlson Comorbidity Index (CCI), anesthetic time, donor site morbidity, and perioperative morbidity score (POMs) were extracted. Patients were contacted to complete the Decision Regret Scale (DRS), University of Washington Quality of Life (UW-QoL), Oral Health Impact-14, and limb specific functional outcome measures. Statistical analyses included a linear regression. RESULTS In total, 97 FFF (mean age 58.5, 62.9% male) and 55 SFF (mean age 64.8, 63.6% male) were included. Total surgical time was higher in the SFF group (p < 0.05) and they had more comorbidities (p < 0.01). SFF patients had lower POM scores on post-operative day three (p < 0.05) while FFF patients scored better on the UW-QoL Physical Domain (p < 0.01). The DRS for both groups (FFF mean DRS 22.7, SFF mean DRS 19.2) was similar. When adjusted for patient morbidity, however, the SFF group had less decisional regret (p < 0.05). CONCLUSION This is the largest comprehensive evaluation of patient-reported outcome measures for FFF and SFFs. SFFs required longer surgical times but had less early morbidity than FFFs. Patients who underwent either reconstructions reported mild decisional regret, proving these are generally well tolerated procedures.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Emily C Deane
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Austin Heffernan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yunqi Ji
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - J Scott Durham
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Eitan Prisman
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada.
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14
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Deane EC, Liu AQ, Nguyen S, Anderson DW, Durham JS, Prisman E. Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction. Head Neck 2021; 44:760-769. [PMID: 34936161 DOI: 10.1002/hed.26963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. METHODS Retrospective series (2015-2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient-reported outcomes. RESULTS Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient-reported outcomes. CONCLUSIONS This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two-team approach are highlighted including decreased operative time.
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Affiliation(s)
- Emily C Deane
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Q Liu
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sally Nguyen
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald W Anderson
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Department of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Versatility of a single piece scapular tip and lateral border free flap for mandibular reconstruction: A virtual study on angle correspondence. Oral Oncol 2021; 121:105379. [PMID: 34140234 DOI: 10.1016/j.oraloncology.2021.105379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
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