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The prefabricated antebrachial fascio-cutaneous flap in reconstructive maxillo-facial surgery
28 Journal of Cranio-MaxillofacialSurgery reports on its surgical morbidity. The surgical access is via a bicoronal flap and oral incision without the need for any skin incision. The osteotomy in the orbit is made inside the lacrimal fossa by retraction of the sac and detachment of the anterior limb of the medial canthal ligament, but without disturbance of the posterior limb. Sixteen patients have undergone Le Fort II osteotomy from 1989 to 1995. There were 10 cleft and 6 non-cleft patients. Early complications included 4 cases of intraoperative orbital fat herniation, 1 periorbital cellulitis, 1 sinusitis, 2 alopecia, and 5 hypoaesthesia of the supra- or infra-orbital nerves. There was no incidence of epiphora or dacrocystitis. Seven of the 16 patients had a mild increase of intermedial canthal distance ranging from 2 to 4 mm. In the long-term, all the coronal scars were well concealed but one patient still complained of mild alopecia and 2 others of scalp numbness. Objective sensory testing revealed 5 patients with supraorbital and 10 with infraorbital hypoaesthesia, but only 3 patients subjectively complained of periorbital numbness. All patients were satisfied (6 reasonable, 10 highly satisfied) with the result and all would recommend (10 recommend, 6 highly recommend) the treatment to other patients. The method minimises surgical morbidity of Le Fort iI and contributes significantly to early recovery.
of tumours of the oral cavity. These flaps were prepared by applying a full-thickness dermal-epidermal graft harvested from the lateral side of the thigh to the fascio-cutaneous tissue of the ventral forearm. After 15-20 days, the prefabricated flap was harvested to obtain a fascio-cutaneous flap that histologically closely resembles the classic Chinese flap, with closure of the previously divaricated skin tissue by first intention, in our opinion, the advantages of this method are as follows: (i) high reliability; (ii) minimal residual scarring at the harvest site, especially as compared to the traditional Chinese fascio-cutaneous flap; (iii) easy execution; and (4) reduced flap thickness as compared to the classical Chinese flap, which is often too thick for the needs of the surgery.
Morphological and Functional Rehabilitation of Severe Mandibular and Maxillary Atrophy by Free Vascularized Flaps
Chiarini L. l, Consolo U3 ~Surgical Department, Dentistry Institute, University of Modena, Modena, Italy 2Institute of Dentistry and MaxilloFacial Surgery, University of Verona, Verona, Italy
Endosseous Implants in Bone Grafted Alveolar Clefts
Chiapasco 114.1,Ronchi P2, Frattini 1).2 ZDepartment of Oral Surgery, S. Paolo Institute of Biomedical Scienees, University of Milan, Milan, Italy 2Department of Maxillo-Facial Surgery, S. Anna Hospital Como, Italy In the last few years, the insertion of endosseous implants for prosthetic rehabilitation of partially or totally edentulous patients with acquired conditions has become common practice, with high percentages of long-term success. However, very little has been experienced about endosseous implants inserted in bone grafted clefts. The authors report their experience in the surgical and prosthetic rehabilitation of patients affected by sequelae of cleft lip and palate, with residual alveolar cleft and absence of maxillary frontal teeth. The patients were treated by means of late secondary bone grafting of the alveolar cleft followed by the insertion of endosseous titanium plasma-sprayed implants (IMZ). After a further healing period, fixed dental prostheses were applied. Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar clefts are a very reliable possibility in dental rehabilitation of this malformation.
The Prefabricated Antebrachial Fascio-Cutaneous Flap in Reconstructive Maxillo-Facial Surgery
Chiarini L. l, Consolo U2 1Surgical Department, Dentistry Institute, University of Modena, Modena, Italy :Institute of Dentistry and Maxillo-Facial Surgery, University of Verona, Verona, Italy Tissue prefabrication aims to create newly formed tissue for use in surgical reconstruction in order to improve aesthetics and reduce scarring at the harvest zone and to optimize flap quality. We employed prefabricated antebrachial fasciocutaneous flaps in 6 patients operated on for debridement
The rehabilitation of severely atrophic mandibular and maxillary alveolar ridge is considered a severe problem. The traditional techniques present several shortcomings such as progressive resorption extrusion or infection of the graft. The diffusion of microvascular free flap procedures has become a predictable therapeutic method. In our experience, microvascular free flaps have a low risk of infection and osteonecrosis and there is no progressive resorption. We present 2 cases of alveolar ridge reconstruction using a free vascularized fibular flap with osseointegrated implants and suggest that it should be considered the method of choice in the extreme alveolar ridge atrophy.
Morphologic Changes of the Irradiated Maxillo-Facial Soft Tissues Restoration in Plastic Surgery
Chomitch S., Chudakov O. Clinicfor Maxillo-Facial and Plastic Surgery, Minsk, Belarus Flat epithelized flap (FEF) is often used in our clinic in operations for penetrating maxillo-facial and neck defect restoration following surgical and X-ray therapy of oncologic conditions. The flap is formed under skin sinking conditions of its autodermograft (ADG). Skin sinking of ADG improves irradiated tissue nourishment in the defect area, the tissues become softer, labile and elastic. Proliferative process in defect margins epithelium during FEF under skin formation improve much more significantly as shown in a clinico-morphologic study of the epidermis of irradiated penetrating maxillo-facial and neck defect areas during staged surgery with FEE The epidermal layer size, DNR-producing cells, index-marked nuclei, and the lithotic-multiplying cells number-lithotic index were determined at the beginning and at the end of the study. The irradiated soft tissues defect margin size increased from 74.0 lak to 14.9.3 gk during the FEF formation. Radioactive isotope marked 3H-thiamidine epidermocyte index increased from 3.88% to 6.9%, lithotic index increased from 1.78% to 2.8%. Such an irradiated tissue proliferative and regenerative processes improvement is very important for successful results of FEF plastic surgery.
of tumours of the oral cavity. These flaps were prepared by applying a full-thickness dermal-epidermal graft harvested from the lateral side of the thigh to the fascio-cutaneous tissue of the ventral forearm. After 15-20 days, the prefabricated flap was harvested to obtain a fascio-cutaneous flap that histologically closely resembles the classic Chinese flap, with closure of the previously divaricated skin tissue by first intention, in our opinion, the advantages of this method are as follows: (i) high reliability; (ii) minimal residual scarring at the harvest site, especially as compared to the traditional Chinese fascio-cutaneous flap; (iii) easy execution; and (4) reduced flap thickness as compared to the classical Chinese flap, which is often too thick for the needs of the surgery.
Morphological and Functional Rehabilitation of Severe Mandibular and Maxillary Atrophy by Free Vascularized Flaps
Chiarini L. l, Consolo U3 ~Surgical Department, Dentistry Institute, University of Modena, Modena, Italy 2Institute of Dentistry and MaxilloFacial Surgery, University of Verona, Verona, Italy
Endosseous Implants in Bone Grafted Alveolar Clefts
Chiapasco 114.1,Ronchi P2, Frattini 1).2 ZDepartment of Oral Surgery, S. Paolo Institute of Biomedical Scienees, University of Milan, Milan, Italy 2Department of Maxillo-Facial Surgery, S. Anna Hospital Como, Italy In the last few years, the insertion of endosseous implants for prosthetic rehabilitation of partially or totally edentulous patients with acquired conditions has become common practice, with high percentages of long-term success. However, very little has been experienced about endosseous implants inserted in bone grafted clefts. The authors report their experience in the surgical and prosthetic rehabilitation of patients affected by sequelae of cleft lip and palate, with residual alveolar cleft and absence of maxillary frontal teeth. The patients were treated by means of late secondary bone grafting of the alveolar cleft followed by the insertion of endosseous titanium plasma-sprayed implants (IMZ). After a further healing period, fixed dental prostheses were applied. Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar clefts are a very reliable possibility in dental rehabilitation of this malformation.
The Prefabricated Antebrachial Fascio-Cutaneous Flap in Reconstructive Maxillo-Facial Surgery
Chiarini L. l, Consolo U2 1Surgical Department, Dentistry Institute, University of Modena, Modena, Italy :Institute of Dentistry and Maxillo-Facial Surgery, University of Verona, Verona, Italy Tissue prefabrication aims to create newly formed tissue for use in surgical reconstruction in order to improve aesthetics and reduce scarring at the harvest zone and to optimize flap quality. We employed prefabricated antebrachial fasciocutaneous flaps in 6 patients operated on for debridement
The rehabilitation of severely atrophic mandibular and maxillary alveolar ridge is considered a severe problem. The traditional techniques present several shortcomings such as progressive resorption extrusion or infection of the graft. The diffusion of microvascular free flap procedures has become a predictable therapeutic method. In our experience, microvascular free flaps have a low risk of infection and osteonecrosis and there is no progressive resorption. We present 2 cases of alveolar ridge reconstruction using a free vascularized fibular flap with osseointegrated implants and suggest that it should be considered the method of choice in the extreme alveolar ridge atrophy.
Morphologic Changes of the Irradiated Maxillo-Facial Soft Tissues Restoration in Plastic Surgery
Chomitch S., Chudakov O. Clinicfor Maxillo-Facial and Plastic Surgery, Minsk, Belarus Flat epithelized flap (FEF) is often used in our clinic in operations for penetrating maxillo-facial and neck defect restoration following surgical and X-ray therapy of oncologic conditions. The flap is formed under skin sinking conditions of its autodermograft (ADG). Skin sinking of ADG improves irradiated tissue nourishment in the defect area, the tissues become softer, labile and elastic. Proliferative process in defect margins epithelium during FEF under skin formation improve much more significantly as shown in a clinico-morphologic study of the epidermis of irradiated penetrating maxillo-facial and neck defect areas during staged surgery with FEE The epidermal layer size, DNR-producing cells, index-marked nuclei, and the lithotic-multiplying cells number-lithotic index were determined at the beginning and at the end of the study. The irradiated soft tissues defect margin size increased from 74.0 lak to 14.9.3 gk during the FEF formation. Radioactive isotope marked 3H-thiamidine epidermocyte index increased from 3.88% to 6.9%, lithotic index increased from 1.78% to 2.8%. Such an irradiated tissue proliferative and regenerative processes improvement is very important for successful results of FEF plastic surgery.