- Email: [email protected]
The microvascular scapular transplant for defect reconstruction in the head and neck region
Int. J. Oral Maxillofac. Surg. 1997; 26 (SuppL 1): 30-148 Printed in Denmark. All rights reserved
Oral Presentations 021-A Reconstructive surgery
1. The Microvascular Scapular Transplant for Defect Reconstruction in the Head and Neck Region
Bill, J. S., Reuther, J. E, Pistner, H., Kuebler, N. R., Reinhart, E.
Department Of Cranio-Maxillo-Facial Surgery, Medical School, University of Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany From 1989 until 1997 the microvascular scapular transplant was ttsed for reconstructions in the cranio-maxillo-facial region in 77 patients. An anatomical examination in dissection of 10 cadavers confirmed a constant vascular pattern of the scapular region. All patients data were collected in a prospective study. The primary diagnosis in most patients was a malignancy (66), mandibular osteoradionecrosis (2), facial gunshot wounds (4) and extreme mandibular atrophy (5). Transplants mostly used were scapular and/or parascapular osteofasciocutaneous transplants (62), fasciocutaneous transplants (3), microvascular bony transplants of the lateral scapular border (10) and osteofasciocutaneous transplants combined with a latissimus dorsi myocutaneous transplant on the common vascular pedicle of the subscapular artery (4-in-l-flap and 3-in-l-flap) (2). Transplantation was performed for reconstruction of the mandibular region (71), reconstruction of the midface region (3), combined reconstruction of the mandibular and midface region (1) and reconstruction of the facial skin (1) or buccal mucosa (1). The postoperative course showed no complications in 55 patients. After treatment of the complications in 13 patients restitution occured in an overall of 68 patients. Measurements of the shoulder movement showed, that 6 months postoperatively in 53 of 57 patients with postoperative physiotherapeutieal training programme of the shoulder region no deficiency of shoulder movement occured. On the other hand there were deficiencies in anteflexion and abduction in 12 of 13 patients that did not follow up the postoperative physiotherapeutical training programme of the shoulder region. In 23 patients with mandibular or maxillary reconstruction we inserted an overall of 108 endosseous BONE L O C K | dental implants (Howmedica-Leibinger, Freiburg, Germany). In 19 patients prosthetic treatment is completed.
2. Stereolithographic Modelling and Massive Human Allograft Skull in the Reconstruction of Extensive CranioOrbital Bony Defects
Schoenaers, j.1, Goffin, j.2, Lechat, A. 3, Guelinckx, e.4, Plets, C), van Calenbergh, E z
Depts. of lMaxillofacial Surgery, 2Neurosurgery, 3Human Tissue Banking, 4Reconstructive Surgery, Caiholic University of Leuven, Belgium Due to trauma and resection extensive bone and soft tissue defects can occur in the cranio-orbital and midfacial region. In order to reconstruct major bony defects, with a peculiar shape, a difficulty resides in obtaining an adequate amount of suitable bone and in shaping it into a normal contour. Donor site morbidity, time investment during surgery and inadequate morphology of the reconstruction are inherent to the use of autogenous bonegrafts. Alloplasts, when used in a one-stage reconstruction, can be preformed and oversized based upon 3D modelling techniques. This technique entails high expenses, and yields a non osseointegrated reconstruction, with no ability to remodel. Lyophilized and gamma irradiated allograft skull is provided on demand by the HumanTissue Bank. Selection of a suitable donor skull is performed based upon a stereolithographic model. Gamma irradiation of this model allows its use as a sterile template during the operative reconstruction of the large cranio-orbital defect. Rigid internal fixation is applied. Three patients, of whom two with recurrent osseous sphenoidal meningeoma of the anterior and middle skull base, and one patient with Mc Cune Albright fibrous dysplasia of the frontal bone, are presented. After major subtotal ablation, orbito-cranial reconstruction was performed using massive allograft donor skull. Healing was uneventful and patients were readily discharged with no residual deformity nor donorsite morbidity. Of major consideration are the vascularisation of the recipient bed, avoidance of intracranial death space and of exposure to the paranasal sinuses.
Oral Presentations 021-A Reconstructive surgery
1. The Microvascular Scapular Transplant for Defect Reconstruction in the Head and Neck Region
Bill, J. S., Reuther, J. E, Pistner, H., Kuebler, N. R., Reinhart, E.
Department Of Cranio-Maxillo-Facial Surgery, Medical School, University of Wuerzburg, Pleicherwall 2, 97070 Wuerzburg, Germany From 1989 until 1997 the microvascular scapular transplant was ttsed for reconstructions in the cranio-maxillo-facial region in 77 patients. An anatomical examination in dissection of 10 cadavers confirmed a constant vascular pattern of the scapular region. All patients data were collected in a prospective study. The primary diagnosis in most patients was a malignancy (66), mandibular osteoradionecrosis (2), facial gunshot wounds (4) and extreme mandibular atrophy (5). Transplants mostly used were scapular and/or parascapular osteofasciocutaneous transplants (62), fasciocutaneous transplants (3), microvascular bony transplants of the lateral scapular border (10) and osteofasciocutaneous transplants combined with a latissimus dorsi myocutaneous transplant on the common vascular pedicle of the subscapular artery (4-in-l-flap and 3-in-l-flap) (2). Transplantation was performed for reconstruction of the mandibular region (71), reconstruction of the midface region (3), combined reconstruction of the mandibular and midface region (1) and reconstruction of the facial skin (1) or buccal mucosa (1). The postoperative course showed no complications in 55 patients. After treatment of the complications in 13 patients restitution occured in an overall of 68 patients. Measurements of the shoulder movement showed, that 6 months postoperatively in 53 of 57 patients with postoperative physiotherapeutieal training programme of the shoulder region no deficiency of shoulder movement occured. On the other hand there were deficiencies in anteflexion and abduction in 12 of 13 patients that did not follow up the postoperative physiotherapeutical training programme of the shoulder region. In 23 patients with mandibular or maxillary reconstruction we inserted an overall of 108 endosseous BONE L O C K | dental implants (Howmedica-Leibinger, Freiburg, Germany). In 19 patients prosthetic treatment is completed.
2. Stereolithographic Modelling and Massive Human Allograft Skull in the Reconstruction of Extensive CranioOrbital Bony Defects
Schoenaers, j.1, Goffin, j.2, Lechat, A. 3, Guelinckx, e.4, Plets, C), van Calenbergh, E z
Depts. of lMaxillofacial Surgery, 2Neurosurgery, 3Human Tissue Banking, 4Reconstructive Surgery, Caiholic University of Leuven, Belgium Due to trauma and resection extensive bone and soft tissue defects can occur in the cranio-orbital and midfacial region. In order to reconstruct major bony defects, with a peculiar shape, a difficulty resides in obtaining an adequate amount of suitable bone and in shaping it into a normal contour. Donor site morbidity, time investment during surgery and inadequate morphology of the reconstruction are inherent to the use of autogenous bonegrafts. Alloplasts, when used in a one-stage reconstruction, can be preformed and oversized based upon 3D modelling techniques. This technique entails high expenses, and yields a non osseointegrated reconstruction, with no ability to remodel. Lyophilized and gamma irradiated allograft skull is provided on demand by the HumanTissue Bank. Selection of a suitable donor skull is performed based upon a stereolithographic model. Gamma irradiation of this model allows its use as a sterile template during the operative reconstruction of the large cranio-orbital defect. Rigid internal fixation is applied. Three patients, of whom two with recurrent osseous sphenoidal meningeoma of the anterior and middle skull base, and one patient with Mc Cune Albright fibrous dysplasia of the frontal bone, are presented. After major subtotal ablation, orbito-cranial reconstruction was performed using massive allograft donor skull. Healing was uneventful and patients were readily discharged with no residual deformity nor donorsite morbidity. Of major consideration are the vascularisation of the recipient bed, avoidance of intracranial death space and of exposure to the paranasal sinuses.