- Email: [email protected]
Donor site morbidity — deep circumflex iliac artery
183 Orbital exenteration — defect classification and reconstructive algorithm M.R. Kesting ∗ , S. Koerdt, N. Rommel, T. Muecke, K.D. Wolff, G. Frohwitter University of Technology Munich, Munich, Germany Background: Orbital exenteration (OE) is a mutilating surgical procedure reserved to neoplastic disorders or extensive facial trauma with unfavourable eye involvement.1 As a multitude of reconstructive procedures exist, it is of crucial importance to offer a disease tailored treatment to gain successful patient outcome.2 Objectives: In order to provide a standardised approach to the surgical procedure of OE we developed a defect driven classification for ablative orbital therapy followed by a reconstructive guideline. Methods: The records of 39 patients who underwent OE from 2007 to 2016 were reviewed. Following the retrospective evaluation we designed a classification and a reconstructive algorithm for OE surgery and reconstruction. Findings: In 26.3% the surgical procedure included solely orbital exenteration and in 73.7% an extended orbital exenteration was performed. The classification refers to the extent of surgical resection. Type I describes resections limited to the orbit. Type II defines additional loss of one (IIa) or more (IIb) orbital walls/rims. Type III embraces cases with skull base penetration. Type IV describes defects with oro-orbital communication. The reconstructive algorithm respects the underlying malignancy, a (neo-)adjuvant therapy and the defect classification. Conclusion: The classification as well as the reconstruction algorithm will help to restore anatomic boundaries and conduct physiological and psychological recovery to the patient.
References 1. Rahman, I., Cook, A. E., & Leatherbarrow, B. (2005). Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol, 89, 1335–1340. 2. Levin, P. S., Ellis, D. S., Stewart, W. B., & Toth, B. A. (1991). Orbital exenteration: the reconstructive ladder. Ophthal Plast Reconstr Surg, 7, 84–92.
http://dx.doi.org/10.1016/j.ijom.2017.02.625 The sandwich technique: an operative approach in the prevention of complications by extensive defects in the head and neck M.R. Kesting ∗ , N. Rommel, S. Koerdt, G. Frohwitter, K.D. Wolff, J. Weitz University of Technology, Munich, Germany Background: The functional and aesthetic reconstruction of head and neck defects with microvascular or pedicled flaps is an established operative technique. However, in cases of large primary tumours, tumour recurrence or osteoradionecrosis, a single flap can be not sufficient because of extensive soft tissue and bone defects. Postoperative complications include intra- and extraoral fistula formation, tissue repair defects, dehiscence and necrosis, all of which could be very difficult to treat. Objectives: A solution to reducing postoperative complications is to make a wider range of tissues available with regard to skin, muscle and bone. For this very reason we have established the sandwich technique. This operative concept comprises two microvascular and/or pedicled flaps, which are taken from
different regions depending on which tissues and vascular structures are needed. Methods: Between 2012 and 2016 the sandwich technique was used on 21 patients. Each operation strictly followed a detailed preoperative planning with the following flaps which were freely combined according to their desired features: fibula free flap; anterolateral thigh; radial forearm flap; tensor fascia lata; latissimus dorsi; deltopectoral flap and pectoralis major flap. Findings: The postoperative results show a sufficient functional and aesthetic reconstruction from complicated and extensive defects within the head and neck region. Conclusion: The sandwich technique proved suitable for complex reconstructions. The extensive variability and options for combinations of flaps is a huge advantage for complicated cases. A sufficient preoperative planning is without doubt important and necessary to achieve a successful outcome. http://dx.doi.org/10.1016/j.ijom.2017.02.626 Donor site morbidity — deep circumflex iliac artery A. Kichenaradjou ∗ , C. Hendy William Harvey Hospital, Ashford, Kent, United Kingdom Deep circumflex iliac artery composite free flap is an ideal bony flap for reconstruction of segmental resection of mandible and in some maxillectomy. The contour of the iliac crest makes it an ideal choice. Donor site morbidity even in extensive bone harvesting is low. The common complications include pain, temporary limping, neuropathy, and herniation of abdominal content. We present a single surgeons experience and rare complication of fracture of the osteotomised end of the anterior superior iliac crest in two patients. http://dx.doi.org/10.1016/j.ijom.2017.02.627 Sectioned images and surface models of a cadaver for understanding the free vascularised anterior rib flap B.C. Kim ∗ , D.S. Shin, H.J. Kim, J. Lee, H.J. Lim Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea Background: The purpose of this study is to describe the vascularised anterior rib flap on sectioned images and surface models using Visible Korean for medical education and clinical training in the field of mandibular reconstructive surgery. Methods: Serially sectioned images of the thorax were obtained from a cadaver. Significant structures in the sectioned images were outlined and stacked to create a surface model. Findings and Conclusions: The PDF file (8.45 MB) of the assembled models can be downloaded for free from our website at http://vkh.ajou.ac.kr/Products/PDF/Vascularized anterior rib flap.zip http://anatomy.co.kr. In this file, important anatomical structures related to the vascularised anterior rib flap can be examined in the sectioned images. All surface models and stereoscopic structures of the vascularised anterior rib flap are expressed in real time. We hope that these stateof-the-art sectioned images, outlined images, and surface models
References 1. Rahman, I., Cook, A. E., & Leatherbarrow, B. (2005). Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol, 89, 1335–1340. 2. Levin, P. S., Ellis, D. S., Stewart, W. B., & Toth, B. A. (1991). Orbital exenteration: the reconstructive ladder. Ophthal Plast Reconstr Surg, 7, 84–92.
http://dx.doi.org/10.1016/j.ijom.2017.02.625 The sandwich technique: an operative approach in the prevention of complications by extensive defects in the head and neck M.R. Kesting ∗ , N. Rommel, S. Koerdt, G. Frohwitter, K.D. Wolff, J. Weitz University of Technology, Munich, Germany Background: The functional and aesthetic reconstruction of head and neck defects with microvascular or pedicled flaps is an established operative technique. However, in cases of large primary tumours, tumour recurrence or osteoradionecrosis, a single flap can be not sufficient because of extensive soft tissue and bone defects. Postoperative complications include intra- and extraoral fistula formation, tissue repair defects, dehiscence and necrosis, all of which could be very difficult to treat. Objectives: A solution to reducing postoperative complications is to make a wider range of tissues available with regard to skin, muscle and bone. For this very reason we have established the sandwich technique. This operative concept comprises two microvascular and/or pedicled flaps, which are taken from
different regions depending on which tissues and vascular structures are needed. Methods: Between 2012 and 2016 the sandwich technique was used on 21 patients. Each operation strictly followed a detailed preoperative planning with the following flaps which were freely combined according to their desired features: fibula free flap; anterolateral thigh; radial forearm flap; tensor fascia lata; latissimus dorsi; deltopectoral flap and pectoralis major flap. Findings: The postoperative results show a sufficient functional and aesthetic reconstruction from complicated and extensive defects within the head and neck region. Conclusion: The sandwich technique proved suitable for complex reconstructions. The extensive variability and options for combinations of flaps is a huge advantage for complicated cases. A sufficient preoperative planning is without doubt important and necessary to achieve a successful outcome. http://dx.doi.org/10.1016/j.ijom.2017.02.626 Donor site morbidity — deep circumflex iliac artery A. Kichenaradjou ∗ , C. Hendy William Harvey Hospital, Ashford, Kent, United Kingdom Deep circumflex iliac artery composite free flap is an ideal bony flap for reconstruction of segmental resection of mandible and in some maxillectomy. The contour of the iliac crest makes it an ideal choice. Donor site morbidity even in extensive bone harvesting is low. The common complications include pain, temporary limping, neuropathy, and herniation of abdominal content. We present a single surgeons experience and rare complication of fracture of the osteotomised end of the anterior superior iliac crest in two patients. http://dx.doi.org/10.1016/j.ijom.2017.02.627 Sectioned images and surface models of a cadaver for understanding the free vascularised anterior rib flap B.C. Kim ∗ , D.S. Shin, H.J. Kim, J. Lee, H.J. Lim Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea Background: The purpose of this study is to describe the vascularised anterior rib flap on sectioned images and surface models using Visible Korean for medical education and clinical training in the field of mandibular reconstructive surgery. Methods: Serially sectioned images of the thorax were obtained from a cadaver. Significant structures in the sectioned images were outlined and stacked to create a surface model. Findings and Conclusions: The PDF file (8.45 MB) of the assembled models can be downloaded for free from our website at http://vkh.ajou.ac.kr/Products/PDF/Vascularized anterior rib flap.zip http://anatomy.co.kr. In this file, important anatomical structures related to the vascularised anterior rib flap can be examined in the sectioned images. All surface models and stereoscopic structures of the vascularised anterior rib flap are expressed in real time. We hope that these stateof-the-art sectioned images, outlined images, and surface models