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PD.46 Microsurgical free flaps in reconstructive surgery: A 5-year one team experience with 135 consecutive cases
Reconstruction 1 were found in the above comparisons. The findings predict 3.71 and 6.78 invasive carcinoma for the experiment group and the control group, respectively, which, in turn, yielded 85.33 additional gains of life years. Analysis of cost-effectiveness shows the incremental costs for detecting additional leukoplakla, nonhomogeneous leukoplakla, reducing one nlore mvaslve carcinoma and gaming one extra life year were NT 180,598, NT 270,897, NT 529,440, and NT 23,019, respectively. Conclusion: Evaluation of the efficacy of screening for leukoplakla with the supplement of Toluidine blue test was performed by the use of a congnumty-based controlled randonnzed trial. No statistical slgmficaace of detecting more leukoplakla has been demonstrated so far but Toluldme blue test may be more efficacious in identifying non-homogeneous leukoplakla despite lacking of statistical significance. From econonnc evaluation, whether Toludme blue test screening is cost-effective m prevention of lnvaslve carcinoma is worthy of being investigated. Tins suggests that long-term follow-up is needed.
Reconstruclion 1
79
Resection of those tumors requires partial or radical maxillectomy following chemoradiaflon therapy. The extension of the resection is variable and depends on the need to obtain tumor free margins. Defects of the hard and soft palate cause several problems such as those with speech, mastication and swallowing. Most of the problems described can be solved by reconstruction of an adequate obturator. Compromised retention, stability and support are the main concern of the prosthettc rehabilitation. In edentulous patients postmaxillectomy, the retention of the obturator becomes a major issue for the patient, and the prostho dotist. Materials and Methods: Will describe a technique for enhancing obturator retention by using the nasal spine area and the remaining of the soft palate. Results: Good retention, and as a result, unproved oral functions were achieved. Conclusion: Quahty of life has been improved since we have been able to restore basic oral functions as speech, mastication and deglutltmn.
Microsurgical free flaps in reconstructive [PD.• surgery: a 5-year one team experience with 135 consecutive cases L. L1, R. Schmelzle. Dept of Oral and Maxlllofaclal Surgery,
IP•
Planning and controlling of reconstructive maxillofacial surgery with computer-assisted radiological diagnostics C. Schaudy, K.-J. Kulez~_kampfl, K. Vmzenz. DepartmentJbr Oral- and Max~Ilofactat Surger); Evangehsches I~)'cmkenhaus Vtenna. Austrta Introduction: Results of maxlllofaclal reconstructive surgery
are critically exannned by 3DCT diagnostics beyond the standard of clinical documentation (photo documentation, representation of functional results by video chps). Materials and Methods: Surgery: = Reconstruction with preformed bone transplants • Reconstruction with prefabricated composite grafts • Distraction Osteoneogenesls Dla~lostlcs: Interactive processing of linked two-dmmusional (2D) and three-dimeusional (3D) Vlsuahzation- and manipulation systems, a 3D cephalometry and the data transfer onto SAM-articulators by the usage of stereo hthography models, are main 1terns of our efforfful planning. Results: Three factors are maportant m this regard: 1) identical size, 2) identical form and 3 ) identical tissue structure m terms of anatomy and microanatomy. It 18 important that ma~xmaum concurrence be achieved between the preformed and composite grafts for restoration m the area of the defect and adjacent anatormc structures. Vectors of the bone distraction are preoperahve calculated. The overall plan is based on a gradual parhal plasmmg, however is always subjected to a permanent controlling as a whole. Conclusion: The highly improved standard of reconstructive OMF-surgery can only been actneved by the exteusive usage of modern computer-asasted plarmmg methods. Permanent controlling of the short-term clinical partml step and the cntmal check of the final result as essentml.
I•
Prosthetic rehabilitation post total maxillectomy
M. Sela, A. Sharon-Bullet. Hadassah Medical Center. Israel Introduction: Tumors reqmrmg maxillary resechon arise from paranasal sinus, palatal epithelium and minor salivary glands.
Unwers~ty Hospital of Hamburg, Germany Introduction: This study is a retrospective review of an 5-year
experience of one team with 135 consecutive mlcrosurglcal free flaps. Materials and Methods: 135 free flaps performed by one teanl m the Department of Oral and Maxlllofaclal Surgery of the umversW hospital of Hanburg from September 1999 to August 2004 were analysed. Regional applications included the head and neck (123/135, 91.1%), lower extrennty ( 10/135, 7.4%), and upper extre,mty (2/135, 1.5%). Donor rotes included the latissnnus dorsi (55), ilnml (32), forearm (18), fibula (15), jejunum (14) and one groin flap. In about 1/3 of the cases, radiation had been given preoperatlvly. Mmrosurgical anastomoses were performed to large-cahber remplent vessels using an interrupted suture techmque; end-to-end anastomoses were preferred with exemptions both m the secondary repa,r o f the head and neck region (end-to-side to the internal jugular veto) and m lower extrennty coverage (end-to-side to the leg artery). Conventional postoperahve flap monitoring methods were used. Results: Ti~e overall success rate for free flap reconstructmn m thas series was 96%. 16 flaps (12.8°%) were reexplored for either anastomotic or bleeding problems, with a salvage rate of 43°4. Arterial problems (4/16, 25%), venous Problem (8/16, 50°4), hematoma or recipient vessel problems (4116, 25°4) were identified as mlderlymg problems. Once arterial msuffimen~ occurred, the salvage rate as much lower (1/4, 25%) m comparison with venous problem (7/8, 86%). two cases requrred veto grafts (one for reexploratmn for venous compromise) m the early stage of our practice. Conclusion: Free-tissue transfer is a successful method m repatrmg defects and is especially a save procedttre for the reconstruchon m radiated regmn. Most of the nncrosurglcal problems m reconstructive surgery were solved by using mdy five free-flap donor sites. The risk as low, once vast amount of knowledge with fewer highly reliable flaps has been acqmred.
Reconstruclion 1
79
Resection of those tumors requires partial or radical maxillectomy following chemoradiaflon therapy. The extension of the resection is variable and depends on the need to obtain tumor free margins. Defects of the hard and soft palate cause several problems such as those with speech, mastication and swallowing. Most of the problems described can be solved by reconstruction of an adequate obturator. Compromised retention, stability and support are the main concern of the prosthettc rehabilitation. In edentulous patients postmaxillectomy, the retention of the obturator becomes a major issue for the patient, and the prostho dotist. Materials and Methods: Will describe a technique for enhancing obturator retention by using the nasal spine area and the remaining of the soft palate. Results: Good retention, and as a result, unproved oral functions were achieved. Conclusion: Quahty of life has been improved since we have been able to restore basic oral functions as speech, mastication and deglutltmn.
Microsurgical free flaps in reconstructive [PD.• surgery: a 5-year one team experience with 135 consecutive cases L. L1, R. Schmelzle. Dept of Oral and Maxlllofaclal Surgery,
IP•
Planning and controlling of reconstructive maxillofacial surgery with computer-assisted radiological diagnostics C. Schaudy, K.-J. Kulez~_kampfl, K. Vmzenz. DepartmentJbr Oral- and Max~Ilofactat Surger); Evangehsches I~)'cmkenhaus Vtenna. Austrta Introduction: Results of maxlllofaclal reconstructive surgery
are critically exannned by 3DCT diagnostics beyond the standard of clinical documentation (photo documentation, representation of functional results by video chps). Materials and Methods: Surgery: = Reconstruction with preformed bone transplants • Reconstruction with prefabricated composite grafts • Distraction Osteoneogenesls Dla~lostlcs: Interactive processing of linked two-dmmusional (2D) and three-dimeusional (3D) Vlsuahzation- and manipulation systems, a 3D cephalometry and the data transfer onto SAM-articulators by the usage of stereo hthography models, are main 1terns of our efforfful planning. Results: Three factors are maportant m this regard: 1) identical size, 2) identical form and 3 ) identical tissue structure m terms of anatomy and microanatomy. It 18 important that ma~xmaum concurrence be achieved between the preformed and composite grafts for restoration m the area of the defect and adjacent anatormc structures. Vectors of the bone distraction are preoperahve calculated. The overall plan is based on a gradual parhal plasmmg, however is always subjected to a permanent controlling as a whole. Conclusion: The highly improved standard of reconstructive OMF-surgery can only been actneved by the exteusive usage of modern computer-asasted plarmmg methods. Permanent controlling of the short-term clinical partml step and the cntmal check of the final result as essentml.
I•
Prosthetic rehabilitation post total maxillectomy
M. Sela, A. Sharon-Bullet. Hadassah Medical Center. Israel Introduction: Tumors reqmrmg maxillary resechon arise from paranasal sinus, palatal epithelium and minor salivary glands.
Unwers~ty Hospital of Hamburg, Germany Introduction: This study is a retrospective review of an 5-year
experience of one team with 135 consecutive mlcrosurglcal free flaps. Materials and Methods: 135 free flaps performed by one teanl m the Department of Oral and Maxlllofaclal Surgery of the umversW hospital of Hanburg from September 1999 to August 2004 were analysed. Regional applications included the head and neck (123/135, 91.1%), lower extrennty ( 10/135, 7.4%), and upper extre,mty (2/135, 1.5%). Donor rotes included the latissnnus dorsi (55), ilnml (32), forearm (18), fibula (15), jejunum (14) and one groin flap. In about 1/3 of the cases, radiation had been given preoperatlvly. Mmrosurgical anastomoses were performed to large-cahber remplent vessels using an interrupted suture techmque; end-to-end anastomoses were preferred with exemptions both m the secondary repa,r o f the head and neck region (end-to-side to the internal jugular veto) and m lower extrennty coverage (end-to-side to the leg artery). Conventional postoperahve flap monitoring methods were used. Results: Ti~e overall success rate for free flap reconstructmn m thas series was 96%. 16 flaps (12.8°%) were reexplored for either anastomotic or bleeding problems, with a salvage rate of 43°4. Arterial problems (4/16, 25%), venous Problem (8/16, 50°4), hematoma or recipient vessel problems (4116, 25°4) were identified as mlderlymg problems. Once arterial msuffimen~ occurred, the salvage rate as much lower (1/4, 25%) m comparison with venous problem (7/8, 86%). two cases requrred veto grafts (one for reexploratmn for venous compromise) m the early stage of our practice. Conclusion: Free-tissue transfer is a successful method m repatrmg defects and is especially a save procedttre for the reconstruchon m radiated regmn. Most of the nncrosurglcal problems m reconstructive surgery were solved by using mdy five free-flap donor sites. The risk as low, once vast amount of knowledge with fewer highly reliable flaps has been acqmred.