Maxillary reconstruction using a bipedicled osteocutaneous scapula flap

Maxillary and total nasal reconstruction with a scapulo dorsal perforator flap

Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.

Complications and Outcomes of Chimeric Free Flaps: A Systematic Review

OBJECTIVE

Ablations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making.

DATA SOURCES

The librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997).

REVIEW METHODS

Candidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates.

RESULTS

A total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively.

CONCLUSION

Chimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.

Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap: a computed tomography imaging study

This study was performed to evaluate the cortical bone resorption of fibular bone after maxillary reconstruction with a fibula free flap. A total of 35 patients with maxillary defects that were repaired using a fibula flap (62 fibula segments) between January 2011 and January 2016 were enrolled. Computed tomography (CT) images taken 1 week and 1 year postoperative were used to evaluate cortical bone resorption. The 62 fibula segments were measured on four different surfaces in the CT images. At 1 week, the thickness of the cortical bone was 2.57 ± 0.58 mm, 2.72 ± 0.46 mm, 3.84 ± 0.98 mm, and 4.36 ± 0.90 mm for the exterior, interior, superior, and inferior sides, respectively. At approximately 1 year, the cortical bone thickness was significantly reduced to 2.00 ± 0.65 mm (P <  0.01), 2.25 ± 0.60 mm (P <  0.01), 3.37 ± 0.90 mm (P <  0.01), and 2.96 ± 0.84 mm (P <  0.01) for the exterior, interior, superior, and inferior sides, respectively. The cortical bone thickness of fibular bone is significantly reduced 1 year after the restoration of maxillary defects with a fibula free flap, most significantly on the inferior side.

Surgical Reconstruction of Maxillary and Mandibular Defects Using a Printed Titanium Mesh

PURPOSE

To reconstruct maxillary and mandibular defects with printed titanium mesh using computer-assisted surgery (CAS) for the achievement of structural, esthetic, and functional goals.

PATIENTS AND METHODS

The authors designed and implemented this prospective study of patients with maxillary or mandibular defects who underwent reconstruction with printed titanium mesh using CAS. After surgery, the preoperative design and postoperative outcome were evaluated using Geomagic Studio software.

RESULTS

The sample was comprised of 2 patients with maxillary defects and 2 with mandibular defects. A satisfactory contour was achieved in all patients. The rate of concordance between the preoperative design and the postoperative outcome was higher than 81 and 94% within 3 mm for the mandibular and maxillary reconstructions, respectively.

CONCLUSION

The results of this study suggest that complicated maxillary and mandibular defects can be satisfactorily reconstructed with customized printed titanium meshes using CAS.

Evolution of complex palatomaxillary reconstructions: the scapular angle osteomuscular free flap

PURPOSE OF REVIEW

This review summarizes the worldwide experience (105 patients) in primary and secondary reconstruction of palatomaxillary oncologic defects with the angular branch-based subscapular system of free flaps, comparing the advantages and disadvantages of the technique with those of other well known osseous donor sites such as the fibula and iliac crest.

RECENT FINDINGS

The most recognized indications for angular branch-based osteomuscular free flaps are class II (especially in association with zygomaticomaxillary buttress and/or floor of the orbit removal) and class III defects according to the Okay classification. Defects involving clearance of the orbital content have also been reconstructed in this manner. One of the most important drawbacks of this technique (i.e., need for intraoperative patient repositioning) is no longer considered an issue, and evidence has been provided that harvesting of angular branch-based scapular flaps may be routinely performed in a supine position. Three-dimensional morphologic similarity of the tip of the scapula with the native hard palate and other maxillary structures makes flap fabrication easy and practical, with at least two (horizontal and vertical) most commonly used flap orientations applied to reconstruct different defects.

SUMMARY

Angular branch-based osteomuscular scapular free flaps represent a major advance in palatomaxillary reconstruction: their versatility, long pedicle with large caliber donor vessels, morphologic similarity with maxillary bony structures, and limited donor-site morbidity compare favorably with those of other osteomuscular and osteomusculocutaneous free flaps described for such challenging reconstructive purposes.