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Fixation of mandibular bone grafts and flaps
Oral Presentation Medial sural artery perforator flap in tongue reconstruction ∗
I. Zubillaga , M. Redondo, R. Gutiérrez, G. Sánchez University Hospital 12 de Octubre, Madrid, Spain Background and objectives: Different free flaps have been used to reconstruct medium-sized defects in tongue after cancer ablation. Traditionally, radial forearm free flap was considered the workhorse in soft tissue intraoral reconstruction. More recently, free medial sural artery perforator flap (MSAPF) has been used as an alternative. The authors investigated the outcome and donor-site morbidity of MSAPF for tongue reconstruction. Methods: Between December 2011 and December 2014, 18 patients (11 men and 7 women) underwent tongue reconstruction with MSAPF in the Oral and Maxillofacial Surgery Department of University Hospital ‘12 de Octubre’ (Madrid, Spain). All patients were treated by the same team. Patients age ranged from 24 to 82 years (mean, 53.8 years). Findings: Success rate of MSAPF was 94.44%. Defects were classified as mobile tongue (n = 14) and base of tongue (n = 4). Flap harvest mean time was 89 min. Length pedicle was 12 cm (10–16 cm), including veins (4–5 mm) with diameter significantly higher than the artery (1.5 mm). Mean flap thickness was 0.9 cm (0.8–1.2 cm). Flap dimensions ranged from 5 to 14 cm in length and flap width was always less than 6 cm to allow direct closure. Overall donor site complication rate was 11.7%. Conclusions: MSAPF is an adequate alternative to reconstruct medium-sized tongue defects. Present less donor site morbidity is compared with other free flaps. Veins diameter is similar to recipient site veins. Disadvantages include learning curve in flap harvest technique, intramuscular dissection and reduced dimensions of the perforators. http://dx.doi.org/10.1016/j.ijom.2015.08.907 Immediate nerve allograft reconstruction with ablation of mandible for benign pathology J. Zuniga University of Texas Southwestern Medical Center at Dallas, TX, USA Background and objectives: Ablation of the mandible for benign pathology requires resection of bone, teeth, soft tissue and inferior alveolar nerve (IAN). This study was designed to determine if the immediate reconstruction of the IAN with AVANCE allograft in conjunction with the simultaneous ablation and reconstruction of the mandible will be effective in restoring sensation of the lip and chin. Methods: Patients (aged 5–70) requiring the ablative resection of the unilateral or bilateral mandible for benign pathology which would include the continuity injury of the IAN were included. The length of the graft must be between 4.5 and 7.0 cm. Sensory values were recorded before and at least twice with the last recording at 6 months postoperatively. Safety data was recorded during the immediate to 6-month postoperative times. Findings: Eight subjects with unilateral mandibular pathology, 4 males and 4 females, mean age was 28, range 11–37. The mean length of discontinuity nerve defect was 56.8, range 55–70. The mean length of allograft was 66.8, range 60–70 × 2–3 mm. Every patient had S4+ (normal) scores preoperatively and the mean score at 6 months postoperatively was S4 in all patients. There were no
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adverse events or recurrences of pathology at these postoperative times. Conclusions: Processed nerve allografts were found to be safe and effective in restoring sensation to the lip and chin in dramatic fashion with 100% reaching useful and functional sensory recovery and >80% reporting similar sensations to preoperative subjective values. http://dx.doi.org/10.1016/j.ijom.2015.08.908 Fixation of mandibular bone grafts and flaps M. Bouzaiene University Hospital Center, Mahdia, Tunisia There have been considerable technical improvements in the devices available for the fixation of bone grafts and flaps to reconstruct mandibular defects. The aim of this paper is to report a series of cases of mandibular reconstruction utilising both designed implants and mini-plates. Through the selected case reports, the authors will define their strategy for holding bone grafts. Results: Long mini-plates are the preferred method for both microvascular fibula flaps, and bone grafts. The impact of heavy devices is reported, along with strategies to avoid complications. Dental implants may be utilised, however the primary goal is to restore mandibular continuity. http://dx.doi.org/10.1016/j.ijom.2015.08.997 Tissue expansion for the repair of operative defects of the face in children M. Bouzaiene University Hospital Center, Mahdia, Tunisia Burn sequelae, posttraumatic lesions and congenital giant nevi can occur on the face of children. Parents are distressed by these events, and there is a pressing demand to remove the disfiguring lesion. Tissue expansions has contributed significantly to the repair these wounds, but are we able to apply this method in the early age and how do we ensure success? Five infants were treated using tissue expansion. Among them three children were operated for congenital nevi of the face, two with enormous nevus located in the fronto-temporo-zygomatic region and a young girl with a same lesion involving her right cheek. One patient had an iatrogenic accident, with a subcutaneous effusion of an intravenously delivered antibiotic and the other was a dog bite defect. In children, two types of expanders have been used one round shaped and the other a crescent shape. The latter is introduced in the cheek using a face-lift incision to hide the scar. The prosthesis is filled once a week with serum. We found that crescent type expander suits very well the parotid region with less exposure. The reconstructive flaps were all advancement flaps. Our cases are well documented and the results are evident with long follow up. Functional and aesthetic outcomes are discussed. http://dx.doi.org/10.1016/j.ijom.2015.08.998
I. Zubillaga , M. Redondo, R. Gutiérrez, G. Sánchez University Hospital 12 de Octubre, Madrid, Spain Background and objectives: Different free flaps have been used to reconstruct medium-sized defects in tongue after cancer ablation. Traditionally, radial forearm free flap was considered the workhorse in soft tissue intraoral reconstruction. More recently, free medial sural artery perforator flap (MSAPF) has been used as an alternative. The authors investigated the outcome and donor-site morbidity of MSAPF for tongue reconstruction. Methods: Between December 2011 and December 2014, 18 patients (11 men and 7 women) underwent tongue reconstruction with MSAPF in the Oral and Maxillofacial Surgery Department of University Hospital ‘12 de Octubre’ (Madrid, Spain). All patients were treated by the same team. Patients age ranged from 24 to 82 years (mean, 53.8 years). Findings: Success rate of MSAPF was 94.44%. Defects were classified as mobile tongue (n = 14) and base of tongue (n = 4). Flap harvest mean time was 89 min. Length pedicle was 12 cm (10–16 cm), including veins (4–5 mm) with diameter significantly higher than the artery (1.5 mm). Mean flap thickness was 0.9 cm (0.8–1.2 cm). Flap dimensions ranged from 5 to 14 cm in length and flap width was always less than 6 cm to allow direct closure. Overall donor site complication rate was 11.7%. Conclusions: MSAPF is an adequate alternative to reconstruct medium-sized tongue defects. Present less donor site morbidity is compared with other free flaps. Veins diameter is similar to recipient site veins. Disadvantages include learning curve in flap harvest technique, intramuscular dissection and reduced dimensions of the perforators. http://dx.doi.org/10.1016/j.ijom.2015.08.907 Immediate nerve allograft reconstruction with ablation of mandible for benign pathology J. Zuniga University of Texas Southwestern Medical Center at Dallas, TX, USA Background and objectives: Ablation of the mandible for benign pathology requires resection of bone, teeth, soft tissue and inferior alveolar nerve (IAN). This study was designed to determine if the immediate reconstruction of the IAN with AVANCE allograft in conjunction with the simultaneous ablation and reconstruction of the mandible will be effective in restoring sensation of the lip and chin. Methods: Patients (aged 5–70) requiring the ablative resection of the unilateral or bilateral mandible for benign pathology which would include the continuity injury of the IAN were included. The length of the graft must be between 4.5 and 7.0 cm. Sensory values were recorded before and at least twice with the last recording at 6 months postoperatively. Safety data was recorded during the immediate to 6-month postoperative times. Findings: Eight subjects with unilateral mandibular pathology, 4 males and 4 females, mean age was 28, range 11–37. The mean length of discontinuity nerve defect was 56.8, range 55–70. The mean length of allograft was 66.8, range 60–70 × 2–3 mm. Every patient had S4+ (normal) scores preoperatively and the mean score at 6 months postoperatively was S4 in all patients. There were no
e179
adverse events or recurrences of pathology at these postoperative times. Conclusions: Processed nerve allografts were found to be safe and effective in restoring sensation to the lip and chin in dramatic fashion with 100% reaching useful and functional sensory recovery and >80% reporting similar sensations to preoperative subjective values. http://dx.doi.org/10.1016/j.ijom.2015.08.908 Fixation of mandibular bone grafts and flaps M. Bouzaiene University Hospital Center, Mahdia, Tunisia There have been considerable technical improvements in the devices available for the fixation of bone grafts and flaps to reconstruct mandibular defects. The aim of this paper is to report a series of cases of mandibular reconstruction utilising both designed implants and mini-plates. Through the selected case reports, the authors will define their strategy for holding bone grafts. Results: Long mini-plates are the preferred method for both microvascular fibula flaps, and bone grafts. The impact of heavy devices is reported, along with strategies to avoid complications. Dental implants may be utilised, however the primary goal is to restore mandibular continuity. http://dx.doi.org/10.1016/j.ijom.2015.08.997 Tissue expansion for the repair of operative defects of the face in children M. Bouzaiene University Hospital Center, Mahdia, Tunisia Burn sequelae, posttraumatic lesions and congenital giant nevi can occur on the face of children. Parents are distressed by these events, and there is a pressing demand to remove the disfiguring lesion. Tissue expansions has contributed significantly to the repair these wounds, but are we able to apply this method in the early age and how do we ensure success? Five infants were treated using tissue expansion. Among them three children were operated for congenital nevi of the face, two with enormous nevus located in the fronto-temporo-zygomatic region and a young girl with a same lesion involving her right cheek. One patient had an iatrogenic accident, with a subcutaneous effusion of an intravenously delivered antibiotic and the other was a dog bite defect. In children, two types of expanders have been used one round shaped and the other a crescent shape. The latter is introduced in the cheek using a face-lift incision to hide the scar. The prosthesis is filled once a week with serum. We found that crescent type expander suits very well the parotid region with less exposure. The reconstructive flaps were all advancement flaps. Our cases are well documented and the results are evident with long follow up. Functional and aesthetic outcomes are discussed. http://dx.doi.org/10.1016/j.ijom.2015.08.998