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A Comparison of Fixation Techniques in Oro-Mandibular Reconstruction Utilizing Fibular Free Flaps
Oral Abstract Session 7
A Comparison of Fixation Techniques in Oro-Mandibular Reconstruction Utilizing Fibular Free Flaps R. Bryan Bell, DDS, MD, FACS, 1849 NW Kearney, Suite 300, Portland, OR, 97209 (Dierks EJ; Potter JK; Beuhler M; Potter BE) Statement: Various fixation techniques have been utilized to stabilize microvascular fibular flaps during reconstruction of composite mandibular defects following ablative surgery. The purpose of this retrospective cohort study was to assess the outcomes of a series of patients that underwent oro-mandibular reconstruction with fibular osteocutaneous free flaps and to determine whether the method of fixation influenced the complication rate, operative time or the esthetic result. Materials and Methods: The records of 100 consecutive patients with post-ablative oro-mandibular defects who underwent reconstruction with fibular osteocutaneous free flaps from 2000-2006 were retrospectively reviewed. Demographic and treatment variables were recorded and analyzed. For purposes of comparison, the study cohort was divided according to the fixation technique: group 1, pre-bent 2.4 or 2.0 mm locking reconstruction plate (with stereolithographic model); group 2, in-situ bent 2.4 or 2.0 mm locking reconstruction plates (no stereolithographic model); group 3, mini-plate fixation. Method of Data Analysis: Descriptive statistics were recorded and the group variables were compared using the chi-square and t-test methods. The primary outcome measures were complications related to fixation failure, operative time or the need for plate removal. Results: The overall success and complication rates of flap reconstruction were 93% and 34% respectively. There was no statistically significant difference in overall complications among the 3 subgroups (p⬎0.5), however, patients with mini-plates required plate removal more frequently (p⬍0.5). Although the use of stereolithographic models to pre-bend the reconstruction plates offered several technical advantages compared to the other methods, there was no significant difference in operative time (p⬎0.5). The use of reconstruction plates was thought to have yielded superior esthetic outcomes when compared to mini-plates. Conclusion: The use of reconstruction plates to stabilize fibular flaps may result in a less frequent need for hardware removal and more predictable esthetics when compared to mini-plate fixation. The use of stereolithographic models to pre-bend plates offers the advantage of precise adaptation regardless of the oncologic requirements during ablative surgery. References Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A. Oromandibular reconstruction using a fibula osteocutaneous free flap: four
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different preplating techniques. Plast Reconstr Surg 118:643-51, 2006 Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 124:46-55, 1998
Experimental Study on Rapid Maxillary Distraction Osteogenesis Using TissueEngineered Osteogenic Material Kazuhiko Kinoshita, DDS, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan (Hibi H; Yamada Y; Ueda M) Statement: In the maxillofacial region, distraction osteogenesis provides autologous and predictable bone formation without grafting procedures but requires a long treatment time which includes latent, lengthening, and consolidation periods. Materials and Methods: Twelve adult male rabbits between 3.0 kg and 3.4 kg underwent bilateral maxillary osteotomies. After a 5 day latency period, a custom-made distraction device was activated at a rate of 2.0 mm per day for 4 days. At the time of the end of distraction, the rabbits were randomly divided into three groups. The rabbits in Group A received injections of tissue-engineered osteogenic material (TEOM) comprising plateletrich plasma (PRP) and autologous mesenchymal stem cells isolated, expanded and induced to osteogenic potential (0.35 mL), those in Group B received injections of PRP (0.35 mL), and those in Group C received injections of saline solution (0.35 mL). The rabbits were sacrificed at 4 weeks after the end of distraction. Method of Data Analysis: Distraction zone was quantitatively evaluated by radiographic and histomorphometric analysis. With an aluminum wedge, exposures were carried out at 2, 3, and 4 weeks after the end of distraction for radiographic analysis. New bone area / distraction zone (%) and (new bone area-void area) / distraction zone (%) were measured for histomorphometric analysis. Results: The radiodensity of the distraction zone was higher in Group A than the other groups at 2, 3, and 4 weeks after the end of distraction. The new bone area / distraction zone (%) in Group A was significantly higher than in the other groups ( p ⬍ 0.05). The (new bone area - void area) / distraction zone (%) in Group A was significantly higher than in the other groups (p ⬍ 0.05). Conclusion: The present study showed that injections of TEOM promoted new bone formation during the rapid distraction osteogenesis. References Tsubota S, Tsuchiya H, Shinokawa Y, Tomita K, Minato H. Transplantation of osteoblast-like cells to distracted callus in rabbits. J Bone Joint Surg Br 1999; 81-B: 125-129 Richards M, Huibregtse BA, Caplan AI, Goulet JA, Goldstein SA. Marrow-derived progenitor cell injections enhance new bone formation during distraction. J Orthop Res 1999; 17: 900-908
AAOMS • 2007
A Comparison of Fixation Techniques in Oro-Mandibular Reconstruction Utilizing Fibular Free Flaps R. Bryan Bell, DDS, MD, FACS, 1849 NW Kearney, Suite 300, Portland, OR, 97209 (Dierks EJ; Potter JK; Beuhler M; Potter BE) Statement: Various fixation techniques have been utilized to stabilize microvascular fibular flaps during reconstruction of composite mandibular defects following ablative surgery. The purpose of this retrospective cohort study was to assess the outcomes of a series of patients that underwent oro-mandibular reconstruction with fibular osteocutaneous free flaps and to determine whether the method of fixation influenced the complication rate, operative time or the esthetic result. Materials and Methods: The records of 100 consecutive patients with post-ablative oro-mandibular defects who underwent reconstruction with fibular osteocutaneous free flaps from 2000-2006 were retrospectively reviewed. Demographic and treatment variables were recorded and analyzed. For purposes of comparison, the study cohort was divided according to the fixation technique: group 1, pre-bent 2.4 or 2.0 mm locking reconstruction plate (with stereolithographic model); group 2, in-situ bent 2.4 or 2.0 mm locking reconstruction plates (no stereolithographic model); group 3, mini-plate fixation. Method of Data Analysis: Descriptive statistics were recorded and the group variables were compared using the chi-square and t-test methods. The primary outcome measures were complications related to fixation failure, operative time or the need for plate removal. Results: The overall success and complication rates of flap reconstruction were 93% and 34% respectively. There was no statistically significant difference in overall complications among the 3 subgroups (p⬎0.5), however, patients with mini-plates required plate removal more frequently (p⬍0.5). Although the use of stereolithographic models to pre-bend the reconstruction plates offered several technical advantages compared to the other methods, there was no significant difference in operative time (p⬎0.5). The use of reconstruction plates was thought to have yielded superior esthetic outcomes when compared to mini-plates. Conclusion: The use of reconstruction plates to stabilize fibular flaps may result in a less frequent need for hardware removal and more predictable esthetics when compared to mini-plate fixation. The use of stereolithographic models to pre-bend plates offers the advantage of precise adaptation regardless of the oncologic requirements during ablative surgery. References Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A. Oromandibular reconstruction using a fibula osteocutaneous free flap: four
39.e4
different preplating techniques. Plast Reconstr Surg 118:643-51, 2006 Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 124:46-55, 1998
Experimental Study on Rapid Maxillary Distraction Osteogenesis Using TissueEngineered Osteogenic Material Kazuhiko Kinoshita, DDS, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan (Hibi H; Yamada Y; Ueda M) Statement: In the maxillofacial region, distraction osteogenesis provides autologous and predictable bone formation without grafting procedures but requires a long treatment time which includes latent, lengthening, and consolidation periods. Materials and Methods: Twelve adult male rabbits between 3.0 kg and 3.4 kg underwent bilateral maxillary osteotomies. After a 5 day latency period, a custom-made distraction device was activated at a rate of 2.0 mm per day for 4 days. At the time of the end of distraction, the rabbits were randomly divided into three groups. The rabbits in Group A received injections of tissue-engineered osteogenic material (TEOM) comprising plateletrich plasma (PRP) and autologous mesenchymal stem cells isolated, expanded and induced to osteogenic potential (0.35 mL), those in Group B received injections of PRP (0.35 mL), and those in Group C received injections of saline solution (0.35 mL). The rabbits were sacrificed at 4 weeks after the end of distraction. Method of Data Analysis: Distraction zone was quantitatively evaluated by radiographic and histomorphometric analysis. With an aluminum wedge, exposures were carried out at 2, 3, and 4 weeks after the end of distraction for radiographic analysis. New bone area / distraction zone (%) and (new bone area-void area) / distraction zone (%) were measured for histomorphometric analysis. Results: The radiodensity of the distraction zone was higher in Group A than the other groups at 2, 3, and 4 weeks after the end of distraction. The new bone area / distraction zone (%) in Group A was significantly higher than in the other groups ( p ⬍ 0.05). The (new bone area - void area) / distraction zone (%) in Group A was significantly higher than in the other groups (p ⬍ 0.05). Conclusion: The present study showed that injections of TEOM promoted new bone formation during the rapid distraction osteogenesis. References Tsubota S, Tsuchiya H, Shinokawa Y, Tomita K, Minato H. Transplantation of osteoblast-like cells to distracted callus in rabbits. J Bone Joint Surg Br 1999; 81-B: 125-129 Richards M, Huibregtse BA, Caplan AI, Goulet JA, Goldstein SA. Marrow-derived progenitor cell injections enhance new bone formation during distraction. J Orthop Res 1999; 17: 900-908
AAOMS • 2007