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Tsuge I, Yamanaka H, Katsube M, Sakamoto M, Morimoto N. Multiple Buttress Reconstruction for Extended Total Maxillectomy by Mixed Use of Vascularized and Nonvascularized Fibula. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5901. [PMID: 38868622 PMCID: PMC11167227 DOI: 10.1097/gox.0000000000005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
Reconstruction of extended total maxillectomy is challenging. This study aimed to isolate the skull base from the nasal cavity to avoid intracranial infection, cerebrospinal fluid fistula, and palate closure to maintain feeding and conversation. However, facial appearance and symmetry are important for quality of life. We report primary multiple buttress reconstruction using a removed nonvascularized fibula that reduced the risk of infection and exposure. A 74-year-old woman experienced a local recurrence of right maxillary sinus cancer after subtotal maxillectomy and postoperative radiotherapy (60 Gy). We performed extended total maxillectomy, including the right eyeball, orbit, temporal bone, palate, and zygomatic arch. Primary reconstruction was performed using fibular and anterolateral thigh free flaps. The proximal fibula bone was resected to obtain the length of the peroneal vessels, and the distal 9 cm of the fibula was made into two pieces while keeping the peroneal vessels attached. The nonvascularized 5-cm fibula was split sagittally with an L-shaped section to maintain the strength of the fragments. An anterolateral thigh flap was elevated from the ipsilateral thigh attached to the partial vastus lateralis muscle, which was divided into proximal (to the cheek skin and prosthetic eye bed) and distal (to the nasal cavity and palate) skin islands. Two nonvascularized bone fragments were fixed at the lateral and infraorbital rims. The dead space around the built-up pillar made of transferred bone was filled with vastus lateralis muscle to prevent infection and depression. This approach allowed for one-stage multiple buttress reconstruction for extended total maxillectomy.
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Affiliation(s)
- Itaru Tsuge
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamanaka
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoki Katsube
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiharu Sakamoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Bernstein JL, Reeve G, Kutler DI, Spector JA. Use of Banked Fibula for Improved Nasal Reconstruction Following Free Fibula Midface Reconstruction. J Craniofac Surg 2024:00001665-990000000-01312. [PMID: 38299811 DOI: 10.1097/scs.0000000000009971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE Anterior maxillary deficiency caused by trauma or oncologic resection presents a complex reconstructive challenge. The authors present a technique for 2-stage midface reconstruction utilizing a vascularized free fibula flap for maxillary reconstruction, followed by nasal reconstruction at a second stage utilizing a banked fibula graft. METHODS This case series utilizes a 2-stage technique for midface reconstruction. In the first stage, a fibula-free flap was used to reconstruct the maxilla with the excess banked in the abdomen. In the second stage, this bone graft was used to restore the nasal dorsum. RESULTS Two patients were included in this series. Patient 1 was a 28-year-old man who presented after a remote gunshot wound to his face, resulting in complete loss of his anterior maxilla and nasal support with midface collapse. Patient 2 was a 65-year-old man who presented with squamous cell carcinoma of the hard palate with extension into the maxilla and nasal septum. In both cases, the flaps healed without complication, providing midface restoration. Placement of the banked fibula graft in a second stage resulted in restoration of dorsal nasal projection. CONCLUSION The authors describe the use of "spare" fibula parts for nasal reconstruction after loss of the maxilla and cartilaginous septum. The use of the fibula bone as a graft to restore the nasal dorsum in a delayed manner allows for a better assessment of the esthetic needs after the massive swelling from the initial surgery has abated. Further, this approach eliminates the need for a second donor site for nasal reconstruction.
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Affiliation(s)
- Jaime L Bernstein
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital
| | - Gwendolyn Reeve
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital
| | - David I Kutler
- Department of Otolaryngology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | - Jason A Spector
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital
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Walatek J, Myśliwiec A, Krakowczyk Ł, Wolański W, Lipowicz A, Dowgierd K. Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review. Eur J Med Res 2023; 28:386. [PMID: 37770987 PMCID: PMC10536701 DOI: 10.1186/s40001-023-01386-y] [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: 06/22/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature. METHODS PEDro, Medline (PubMed), Cochrane Clinical Trials were searched. RESULTS 767 articles were found. 40 articles were included to this literature review. CONCLUSIONS Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.
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Affiliation(s)
- Julia Walatek
- Department of Science, Innovation and Development, Galen-Orthopedics, 43-150 Bierun, Poland
| | - Andrzej Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland
| | - Łukasz Krakowczyk
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland
| | - Anna Lipowicz
- Department of Anthropology, Institute of Environmental Biology, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland
| | - Krzysztof Dowgierd
- Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, 10-561 Olsztyn, Poland
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Hwang BY, Noh K, Lee JW. Long-Term Follow-Up of a Novel Surgical Option Combining Fibula Free Flap and 3D-Bioprinted, Patient-Specific Polycaprolactone (PCL) Implant for Mandible Reconstruction. Bioengineering (Basel) 2023; 10:684. [PMID: 37370615 DOI: 10.3390/bioengineering10060684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
As the fibula free flap became the gold standard in mandibular reconstruction that required both hard tissue and soft tissue, various methods have been sought to solve the height discrepancy between the mandible and fibula. The purpose of this paper was to propose a surgical option that combined the microvascular fibula free flap with a 3D-bioprinted, patient-specific polycaprolactone (PCL) implant as a safe and simple novel method that achieved the best functional and aesthetic results in mandibular reconstruction surgery for young patients with malignant tumors. The patient's reconstructed mandible maintained volume symmetry without any deformation or complications for over 6 years. Computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing technology enabled accurate and safe surgical results.
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Affiliation(s)
- Bo-Yeon Hwang
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul 02447, Republic of Korea
| | - Kwantae Noh
- Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
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Prosthetically guided mandibular reconstruction using a fibula free flap: three-dimensional Bologna plate, an alternative to the double-barrel technique. Int J Oral Maxillofac Surg 2023; 52:436-441. [PMID: 36038455 DOI: 10.1016/j.ijom.2022.08.006] [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: 12/22/2021] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
The fibula free flap represents the gold standard for mandibular reconstruction. However, when harvested as a single barrel, this flap does not allow the native mandibular height to be restored, which is required for implant-supported dental rehabilitation of the patient. The aim of this study was to present a new design for a patient-specific three-dimensionally printed reconstructive plate (3DBO-PSI) that positions the fibula bone at the height of the resected mandibular alveolar bone while restoring the mandibular profile to ensure a correct morphological outcome. Twenty patients were enrolled prospectively between January 2019 and May 2022. All patients underwent a segmental mandibular resection and prosthetically guided reconstruction making use of a fibula free flap supported by the 3DBO-PSI. The mean follow-up period was 20 months. All microvascular and implant-related complications were recorded. Microvascular failure occurred in two patients. No PSI-related complications were recorded during the postoperative follow-up. The proposed reconstructive method was found to be reliable and reproducible. In all treated patients, the bony flap appeared to be adequately positioned to maintain the preoperative intermaxillary relationship, as planned. To date, dental rehabilitation has been completed in seven patients.
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Assembly of 3D-printed Ti scaffold and free vascularized fibula using a customized Ti plate for the reconstruction of mandibular defects. Biodes Manuf 2022. [DOI: 10.1007/s42242-021-00181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Perez PI, Sloneker DR, Bloom AG, Vincent AG, Hohman MH, Harsha WJ, Anderson KG. Non-vascularized Fibular Cortex Grafts with Osteocutaneous Free Fibula Transfer: A Novel Technique in Midface Reconstruction. Ann Otol Rhinol Laryngol 2020; 130:843-847. [PMID: 33228400 DOI: 10.1177/0003489420972734] [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: 11/16/2022]
Abstract
OBJECTIVES To present a method to reconstruct the midface using the fibula as both a microvascular free flap and as a free cortex graft. METHODS 22-year-old male presented with bilateral maxillary odonotogenic myxoma. Bilateral total maxillectomy defects were reconstructed using an osteocutaneous fibula free flap. The nasomaxillary buttresses were augmented using free cortex grafts to provide additional soft tissue projection and lateral nasal support. RESULTS The patient received dental implants at 10 months postoperatively and resumed a normal diet. His midface height, nasal and maxillary projection were adequate. At 36 months post-treatment he has no evidence of disease recurrence or resorption of the free bone grafts. CONCLUSION The fibula free flap can be used to provide additional support to a patient's reconstruction by means of free cortex grafts. The patient has had successful restoration of pyriform aperture, nasal projection, mastication, and dental restoration using a single donor site.
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Affiliation(s)
- Paloma I Perez
- Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Del R Sloneker
- Department of Otolaryngology - Head and Neck Surgery, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Ashlie G Bloom
- Touro University Nevada Osteopathic Medicine, Henderson, NV, USA
| | - Aurora G Vincent
- Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Marc H Hohman
- Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Wayne J Harsha
- Ears, Nose, Throat & Allergy Associates, Puyallap, WA, USA
| | - Kelly G Anderson
- Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Lu Y, Ma T, Ren C, Li Z, Sun L, Xue H, Li M, Zhang K, Zhang C, Wang Q. Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate. J Int Med Res 2020; 48:300060520920407. [PMID: 32351151 PMCID: PMC7218946 DOI: 10.1177/0300060520920407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.
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Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Congming Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University, Shan'xi, China
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