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Long term perfusion of composite free flap
P22-5 Distraction osteogenesis and BMP & Reconstructive surgery
6. Long-term Observation and Reevaluation of a Custommade Casting Titanium Plate in Mandibular Reconstruction
Yamaguchi, A., Kamitaki, T., Uchida, H., Nakamura, N., Yamatsuta, T., Furuya, S., Ninomiya, N., Hiroyasu, K., Mizutani, M., Minazawa, H., Tsuchikawa, K. Department of OMFS 1, School of Dentistry at Niigata, The Nippon Dental Univ., Niigata, Japan As mandibular reconstruction plates prevail throughout the world for the primary reconstruction of the mandible, we previously reported on the availability of a custom-made casting titanium plate for that purpose (Jpn J Oral Maxillofac Surg 1995: 41: 305-14). We present a clinical study consisting of long-term follow-up and revaluation. Eight cases of mandibular reconstruction with a custommade plate were used for the assessment, consisting of five cases of carcinoma of the mandible, and one case each of ameloblastoma, ankylosis in the TMJ, and a missing condylar head caused by trauma. A custom-made titanium plate was cast from the wax pattern molded from the patient's real-size mandibular model which was derived by piling up several acrylic plates according to CT scan films. Five cases out of eight were satisfactory in reconstruction as well as in the contouring of the mandible. They have remained functional for more than eight years (average, 9.5years). However, in three cases, the plate had to be removed due to infection and screw trouble.
7. Long Term Perfusion of Composite Free Flap
McVicar, L H., Fishe~ S. E., Wastie, 3/1. L., Perkins, A. C., Vincent, R. M. Maxillofacial Unit and Department of Medical Physics, Queen's Medical Centre, Nottingham, UK Bone scans are used routinely to help in determining whether the mandible may be invaded by tumour. They are also used to confirm the viability of bony free flaps used to repair defects following ablative tumour surgery. Short term studies have shown that a viable bone free flap appears as a "hot" bone scan. It is not known whether the bone scan remains "hot" over a longer period. Aim
The aim of this study was to establish whether the bone scan remains "hot" after a period of at least one year. What happens to the appearance of the bone scan as these flaps mature has been unknown. This has" lead to the inability to interpret later bone scans particularly when recurrence is suspected or new primary disease presents. The practical significance of this study is to avoid unnecessary morbidity and needless sacrifice of free flaps when later surgery is necessary for recurrence or new primary disease. Nine patients were entered into an ethically approved trial.
213
Technetium bone scans were performed in all cases at least one year following surgery. Results There is no increase in bony uptake in free flaps as measured by Technetium bone scans after at least one year. Conclusions The activity of the bone in the composite free flap as measured by Technetium bone scans returns to normal levels within one year.
8. Clinical Studies of Mandibular Reconstruction Using Vascularized and Non-Vascularized Iliac Crest
Kawaguchi, K., Sato, s Matsuura, M., Seto, K. First Department of Oral and Maxillofacial Surgery, Tsurumi Uni., TsurumL Yokohama, Japan We have already reported that the ilium has the most sufficient bone shape and volume in terms of both thickness and height to be used for reconstruction of the mandible. Thus, we would like to report the results of a clinical study of 85 patients who were underwent reconstruction of the mandible, 51 using non-vascularized iliac crest (NVIC) and 34 using vascularized iliac crest (VIC). The procedure used for resection of the mandibule was unilateral segmentectomy in 23 patients, bilateral segmentectomy in 15 patients, hemimandibulectomy in 10 patients and marginal resection in 3 of the 51 NVIC patients; unilateral segmentectomy in 24 patients, bilateral segmentectomy in 8 patients, and hemimandibulectomy in 2 of the 34 VIC patients. The mandible underwent primary reconstruction in 25 of the 51 NVIC patients and 29 of the 34 VIC patients. For the skin flap, the forearm flap was used in 17 of VIC patients. Complications observed were gait disturbance in 13 of the 51 NVIC patients (25%) and 20 of the 34 V_IC patients (59%) at the third month after operation, but this disturbance was resolved within one year. Dysesthesia of the femoral region was experienced by 16 of the 34 VIC patients and disappeared within one year after the operation in most cases. The NVIC bad to be removed in 10 of the 51 patients (20%) and the VIC had to be removed in three of the 34 patients (9%). The reasons for removal were necrosis of the groin flap in one VIC patient, vessel trouble in two VIC patients, perforation of the P M M C in one patient and infections of iliac bones in the other patients. The absorption rate of grafted bone was measured by orthopantomography. Three years after bone grafts, the average bone resorption rate was about 35% in 35 N V I C and 5% in 30 VIC patients. It is concluded that the use of VIC in one-stage operations for reconstruction of the mandible is useful for wearing dentures early after the operation and in facilitating the recovery of mastication and facial appearance; and serious complications do not occur. VIC is indicated in large unilateral and bilateral segmentectomy, hemimandibulectomy, and osteomyelitis cases and NVIC is indicated in small unilateral segmentectomy from part of the premolar region to the ramus of the mandible in secondary reconstruction.
6. Long-term Observation and Reevaluation of a Custommade Casting Titanium Plate in Mandibular Reconstruction
Yamaguchi, A., Kamitaki, T., Uchida, H., Nakamura, N., Yamatsuta, T., Furuya, S., Ninomiya, N., Hiroyasu, K., Mizutani, M., Minazawa, H., Tsuchikawa, K. Department of OMFS 1, School of Dentistry at Niigata, The Nippon Dental Univ., Niigata, Japan As mandibular reconstruction plates prevail throughout the world for the primary reconstruction of the mandible, we previously reported on the availability of a custom-made casting titanium plate for that purpose (Jpn J Oral Maxillofac Surg 1995: 41: 305-14). We present a clinical study consisting of long-term follow-up and revaluation. Eight cases of mandibular reconstruction with a custommade plate were used for the assessment, consisting of five cases of carcinoma of the mandible, and one case each of ameloblastoma, ankylosis in the TMJ, and a missing condylar head caused by trauma. A custom-made titanium plate was cast from the wax pattern molded from the patient's real-size mandibular model which was derived by piling up several acrylic plates according to CT scan films. Five cases out of eight were satisfactory in reconstruction as well as in the contouring of the mandible. They have remained functional for more than eight years (average, 9.5years). However, in three cases, the plate had to be removed due to infection and screw trouble.
7. Long Term Perfusion of Composite Free Flap
McVicar, L H., Fishe~ S. E., Wastie, 3/1. L., Perkins, A. C., Vincent, R. M. Maxillofacial Unit and Department of Medical Physics, Queen's Medical Centre, Nottingham, UK Bone scans are used routinely to help in determining whether the mandible may be invaded by tumour. They are also used to confirm the viability of bony free flaps used to repair defects following ablative tumour surgery. Short term studies have shown that a viable bone free flap appears as a "hot" bone scan. It is not known whether the bone scan remains "hot" over a longer period. Aim
The aim of this study was to establish whether the bone scan remains "hot" after a period of at least one year. What happens to the appearance of the bone scan as these flaps mature has been unknown. This has" lead to the inability to interpret later bone scans particularly when recurrence is suspected or new primary disease presents. The practical significance of this study is to avoid unnecessary morbidity and needless sacrifice of free flaps when later surgery is necessary for recurrence or new primary disease. Nine patients were entered into an ethically approved trial.
213
Technetium bone scans were performed in all cases at least one year following surgery. Results There is no increase in bony uptake in free flaps as measured by Technetium bone scans after at least one year. Conclusions The activity of the bone in the composite free flap as measured by Technetium bone scans returns to normal levels within one year.
8. Clinical Studies of Mandibular Reconstruction Using Vascularized and Non-Vascularized Iliac Crest
Kawaguchi, K., Sato, s Matsuura, M., Seto, K. First Department of Oral and Maxillofacial Surgery, Tsurumi Uni., TsurumL Yokohama, Japan We have already reported that the ilium has the most sufficient bone shape and volume in terms of both thickness and height to be used for reconstruction of the mandible. Thus, we would like to report the results of a clinical study of 85 patients who were underwent reconstruction of the mandible, 51 using non-vascularized iliac crest (NVIC) and 34 using vascularized iliac crest (VIC). The procedure used for resection of the mandibule was unilateral segmentectomy in 23 patients, bilateral segmentectomy in 15 patients, hemimandibulectomy in 10 patients and marginal resection in 3 of the 51 NVIC patients; unilateral segmentectomy in 24 patients, bilateral segmentectomy in 8 patients, and hemimandibulectomy in 2 of the 34 VIC patients. The mandible underwent primary reconstruction in 25 of the 51 NVIC patients and 29 of the 34 VIC patients. For the skin flap, the forearm flap was used in 17 of VIC patients. Complications observed were gait disturbance in 13 of the 51 NVIC patients (25%) and 20 of the 34 V_IC patients (59%) at the third month after operation, but this disturbance was resolved within one year. Dysesthesia of the femoral region was experienced by 16 of the 34 VIC patients and disappeared within one year after the operation in most cases. The NVIC bad to be removed in 10 of the 51 patients (20%) and the VIC had to be removed in three of the 34 patients (9%). The reasons for removal were necrosis of the groin flap in one VIC patient, vessel trouble in two VIC patients, perforation of the P M M C in one patient and infections of iliac bones in the other patients. The absorption rate of grafted bone was measured by orthopantomography. Three years after bone grafts, the average bone resorption rate was about 35% in 35 N V I C and 5% in 30 VIC patients. It is concluded that the use of VIC in one-stage operations for reconstruction of the mandible is useful for wearing dentures early after the operation and in facilitating the recovery of mastication and facial appearance; and serious complications do not occur. VIC is indicated in large unilateral and bilateral segmentectomy, hemimandibulectomy, and osteomyelitis cases and NVIC is indicated in small unilateral segmentectomy from part of the premolar region to the ramus of the mandible in secondary reconstruction.