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54 The versatility of the scapula-thoracodorsal artery perforator flap in head and neck reconstruction
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Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
51 Head, face and neck injuries sustained by British servicemen in Iraq and Afghanistan: 01 March 2003 – 31 December 2008 J. Breeze, A.J. Gibbons, C. Shief, G. Banfield, D.G. Bryant, M.J. Midwinter. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK Introduction: Reviews from US forces in Iraq and Afghanistan in the 21st century describe incidences of head, face and neck injuries ranging from 21% to 29%. This is a significant increase from incidences published for conflicts in the 20th century. No review has to date exclusively analysed head, face and neck injuries sustained by UK personnel in the 21st century. Method: All head, face and neck (HFN) injuries sustained by British forces in Iraq and Afghanistan from 01 March 2003 to 31 December 2008 were analysed. Data for this research was obtained from the Joint Theatre Trauma Registry (JTTR), the operating theatre log of the Multinational Field hospital in Kandahar and the Defence Analytical and Statistical Agency (DASA). Results: During this period the HFN area accounted for 27% of battle injuries in 2006, 29% of battle injuries in 2007 and 30% of battle injuries in 2008. This gave an overall incidence during this period of 29%. 86% of HFN injuries were sustained in battle. Of those sustaining HFN injuries, 32% were killed in action and 6% died of wounds. 73% of injuries required evacuation back to the UK whilst 27% of injuries were managed definitively in the theatre of operations. Conclusions: The rise in incidence of HFN injuries in comparison to 20th century conflicts most likely reflects improvements in body armour and the increased use of improvised explosive devices. It also reinforces the need for developing new methods of protecting the vulnerable head, face and neck regions in military conflicts. 52 Skin graft fixation with cyanoacrylate tissue adhesive in facial skin cancer patients A. Kamisetty, D.G. Snow. Wrexham Maelor Hospital, UK Introduction: Full thickness skin grafts (FTSG) are commonly used to reconstruct the defeccts following facial skin cancer surgery. Traditionally, most FTSG are secured using sutures. Since the introduction of cyanoacrylate tissue adhesives, multiple studies have consistently demonstrated that wound closure with cyanoacrylate is comparable with suturing. Aim: To assess the effectiveness of a cyanoacrylate tissue adhesive for securing FTSG. Methods: ENT department in wrexham maelor hospital has been using cyanoacrylate tissue adhesive since 1999 to secure FTSG following skin cancer surgery. The data was collected from the prospectively maintained data base for skin cancer, during the period January 2000 to august 2009. Total 121 FTSG were performed. There are 73 (60%) male and 48 (40%) female patients in the group with age range of 50–94 years. Results: Majority of patients had basal cell carcinoma (84%). Nose (82%) and pinna (9%) being the main recipient sites. The graft size varied from 10mm to 40mm. The success rate was 93%.with complication rate of 9.9%.The infection rate was 1.65%. Conclusion: Cyanoacrylate tissue adhesive is effective in securing FTSG with low complication rate and good cosmetic outcome. This found to be safe and prevents needle stick injury. This technique is simple to useand easy to learn. Provides a significant time saving over traditional approach of suturing.
53 A randomised prospective trial comparing bioabsorbable versus titanium plates in the treatment of mandibular and zygomatic fractures J. Green, P. Praveen, V. Lopes, K. Webster. University Hospitals Birmingham NHS Foundation Trust, UK Introduction: Studies have shown that there is a need for removal of titanium fixation plates as a result of exposure and/or infection. The development of resorbable plates has potentially offered a solution to this problem. We present a randomised controlled trial comparing a bioresorbable to a titanium fixation system. Method: All patients presenting to the maxillofacial trauma service at University Hospital Birmingham with mandibular and maxillary fractures were randomised to two treatment arms (titanium or Inion™ plate fixation). The inclusion criteria were all healthy adults with zygomatic or mandibular fractures. Following randomisation patients proceeded to one of the treatment arms. Patients were reviewed at one week, six weeks, six months and twelve months. Data collected included ease of operation and post-operative complications. An interim analysis was performed after 34 cases. Results: Sixteen patients had conventional titanium fixation and eighteen had resorbable fixation. Seven of the patients having Inion™ fixation had evidence of significant peri-operative problems compared to one with titanium fixation. Using Chi2 analysis, this difference was statistically significant (p = 0.02). Conclusions: Whilst the number of patients involved in the study was small, the significant number of complications related to the resorbable plates resulted in early stopping of the trial. The advantages of resorbable plates were outweighed by the significant peri-operative morbidity associated with their use. Only one resorbable system was used as it was the only system licensed for mandibular trauma. Advances in bioresorbable materials may make these materials useful in trauma management in the future. 54 The versatility of the scapula-thoracodorsal artery perforator flap in head and neck reconstruction K. McVeigh, T. Martin, S. Parmar. University Hospital Birmingham, UK Introduction: The scapula osseocutaneous flap has a well established role in head and neck reconstructive surgery. The flap’s versatility can be further improved by inclusion of the thoracodorsal artery perforator and scapula angular vessels on the same pedicle. This modification to the conventional scapula flap provides unparalleled potential for the reconstruction of complex 3-dimensional defects but reports of its use are confined to a single paper describing a case of maxillary reconstruction. We present our early results in using these modifications in mandibular, maxillary and combined reconstruction. We will present the first reported case of mandibular reconstruction using this flap. Methods: The technique of flap harvest is discussed along with relevant anatomy of the subscapular vascular system. The versatility of the resultant composite flap with multiple soft tissue and bony components based on a single pedicle is demonstrated. Results: Early results have been very encouraging. We have successfully reconstructed complex maxillary, mandibular and combined defects. Prior to the introduction of this technique more than one free flap would have potentially been required to produce the same standard of reconstruction. Conclusions: The Maxillofacial Team at University Hospital Birmingham now consider the thoracodorsal artery perforator scapula flap as an option when planning complex cases given its potential for reconstruction and the benefits of a single donor site.
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
51 Head, face and neck injuries sustained by British servicemen in Iraq and Afghanistan: 01 March 2003 – 31 December 2008 J. Breeze, A.J. Gibbons, C. Shief, G. Banfield, D.G. Bryant, M.J. Midwinter. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK Introduction: Reviews from US forces in Iraq and Afghanistan in the 21st century describe incidences of head, face and neck injuries ranging from 21% to 29%. This is a significant increase from incidences published for conflicts in the 20th century. No review has to date exclusively analysed head, face and neck injuries sustained by UK personnel in the 21st century. Method: All head, face and neck (HFN) injuries sustained by British forces in Iraq and Afghanistan from 01 March 2003 to 31 December 2008 were analysed. Data for this research was obtained from the Joint Theatre Trauma Registry (JTTR), the operating theatre log of the Multinational Field hospital in Kandahar and the Defence Analytical and Statistical Agency (DASA). Results: During this period the HFN area accounted for 27% of battle injuries in 2006, 29% of battle injuries in 2007 and 30% of battle injuries in 2008. This gave an overall incidence during this period of 29%. 86% of HFN injuries were sustained in battle. Of those sustaining HFN injuries, 32% were killed in action and 6% died of wounds. 73% of injuries required evacuation back to the UK whilst 27% of injuries were managed definitively in the theatre of operations. Conclusions: The rise in incidence of HFN injuries in comparison to 20th century conflicts most likely reflects improvements in body armour and the increased use of improvised explosive devices. It also reinforces the need for developing new methods of protecting the vulnerable head, face and neck regions in military conflicts. 52 Skin graft fixation with cyanoacrylate tissue adhesive in facial skin cancer patients A. Kamisetty, D.G. Snow. Wrexham Maelor Hospital, UK Introduction: Full thickness skin grafts (FTSG) are commonly used to reconstruct the defeccts following facial skin cancer surgery. Traditionally, most FTSG are secured using sutures. Since the introduction of cyanoacrylate tissue adhesives, multiple studies have consistently demonstrated that wound closure with cyanoacrylate is comparable with suturing. Aim: To assess the effectiveness of a cyanoacrylate tissue adhesive for securing FTSG. Methods: ENT department in wrexham maelor hospital has been using cyanoacrylate tissue adhesive since 1999 to secure FTSG following skin cancer surgery. The data was collected from the prospectively maintained data base for skin cancer, during the period January 2000 to august 2009. Total 121 FTSG were performed. There are 73 (60%) male and 48 (40%) female patients in the group with age range of 50–94 years. Results: Majority of patients had basal cell carcinoma (84%). Nose (82%) and pinna (9%) being the main recipient sites. The graft size varied from 10mm to 40mm. The success rate was 93%.with complication rate of 9.9%.The infection rate was 1.65%. Conclusion: Cyanoacrylate tissue adhesive is effective in securing FTSG with low complication rate and good cosmetic outcome. This found to be safe and prevents needle stick injury. This technique is simple to useand easy to learn. Provides a significant time saving over traditional approach of suturing.
53 A randomised prospective trial comparing bioabsorbable versus titanium plates in the treatment of mandibular and zygomatic fractures J. Green, P. Praveen, V. Lopes, K. Webster. University Hospitals Birmingham NHS Foundation Trust, UK Introduction: Studies have shown that there is a need for removal of titanium fixation plates as a result of exposure and/or infection. The development of resorbable plates has potentially offered a solution to this problem. We present a randomised controlled trial comparing a bioresorbable to a titanium fixation system. Method: All patients presenting to the maxillofacial trauma service at University Hospital Birmingham with mandibular and maxillary fractures were randomised to two treatment arms (titanium or Inion™ plate fixation). The inclusion criteria were all healthy adults with zygomatic or mandibular fractures. Following randomisation patients proceeded to one of the treatment arms. Patients were reviewed at one week, six weeks, six months and twelve months. Data collected included ease of operation and post-operative complications. An interim analysis was performed after 34 cases. Results: Sixteen patients had conventional titanium fixation and eighteen had resorbable fixation. Seven of the patients having Inion™ fixation had evidence of significant peri-operative problems compared to one with titanium fixation. Using Chi2 analysis, this difference was statistically significant (p = 0.02). Conclusions: Whilst the number of patients involved in the study was small, the significant number of complications related to the resorbable plates resulted in early stopping of the trial. The advantages of resorbable plates were outweighed by the significant peri-operative morbidity associated with their use. Only one resorbable system was used as it was the only system licensed for mandibular trauma. Advances in bioresorbable materials may make these materials useful in trauma management in the future. 54 The versatility of the scapula-thoracodorsal artery perforator flap in head and neck reconstruction K. McVeigh, T. Martin, S. Parmar. University Hospital Birmingham, UK Introduction: The scapula osseocutaneous flap has a well established role in head and neck reconstructive surgery. The flap’s versatility can be further improved by inclusion of the thoracodorsal artery perforator and scapula angular vessels on the same pedicle. This modification to the conventional scapula flap provides unparalleled potential for the reconstruction of complex 3-dimensional defects but reports of its use are confined to a single paper describing a case of maxillary reconstruction. We present our early results in using these modifications in mandibular, maxillary and combined reconstruction. We will present the first reported case of mandibular reconstruction using this flap. Methods: The technique of flap harvest is discussed along with relevant anatomy of the subscapular vascular system. The versatility of the resultant composite flap with multiple soft tissue and bony components based on a single pedicle is demonstrated. Results: Early results have been very encouraging. We have successfully reconstructed complex maxillary, mandibular and combined defects. Prior to the introduction of this technique more than one free flap would have potentially been required to produce the same standard of reconstruction. Conclusions: The Maxillofacial Team at University Hospital Birmingham now consider the thoracodorsal artery perforator scapula flap as an option when planning complex cases given its potential for reconstruction and the benefits of a single donor site.