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Tidke SS, Waknis PP, Setiya S, Jain KM, Gupta D, Sakhariya S. Donor Site Morbidity in Patients Undergoing Maxillofacial Reconstruction Using Free Fibula Flap Versus Deep Circumflex Artery Flap-A Systematic Review. J Maxillofac Oral Surg 2024; 23:597-607. [PMID: 38911406 PMCID: PMC11189870 DOI: 10.1007/s12663-022-01698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction. Materials and methods The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps. Results A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap. Conclusion The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).
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Affiliation(s)
- Sanika S. Tidke
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018 India
| | - Pushkar P. Waknis
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018 India
| | - Sneha Setiya
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018 India
| | | | | | - Samkit Sakhariya
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018 India
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Scampa M, Mégevand V, Martineau J, Schaefer DJ, Kalbermatten DF, Oranges CM. Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5708. [PMID: 38596574 PMCID: PMC11000773 DOI: 10.1097/gox.0000000000005708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024]
Abstract
Background Recalcitrant bone nonunion and osseous defect treatment is challenging and often requires vascularized bone transfer. The medial femoral condyle flap has become an increasingly popular option for reconstruction. The study aims at reviewing its different applications and synthesizing its surgical outcomes. Method A systematic review including all studies assessing surgical outcomes of free medial femoral condyle flap for bone reconstruction in adults was conducted on January 31, 2023. Flap failure and postoperative complications were synthesized with a proportional meta-analysis. Results Forty articles describing bony reconstruction in the head and neck, upper limb, and lower limb areas were selected. Indications ranged from bony nonunion and bone defects to avascular bone necrosis. Multiple flaps were raised as either pure periosteal, cortico-periosteal, cortico-cancellous-periosteal, or cortico-chondro-periosteal. A minority of composite flaps were reported. Overall failure rate was 1% [95% confidence interval (CI), 0.00-0.08] in head & neck applications, 4% in the lower limb (95% CI, 0.00-0.16), 2% in the upper limb (95% CI, 0.00-0.06), and 1% in articles analyzing various locations simultaneously (95% CI, 0.00-0.04). Overall donor site complication rate was 4% (95% CI, 0.01-0.06). Major reported complications were: femoral fractures (n = 3), superficial femoral artery injury (n = 1), medial collateral ligament injury (n = 1), and septic shock due to pace-maker colonization (n = 1). Conclusion The medial femoral condyle flap is a versatile option for bone reconstruction with high success rates and low donor site morbidity.
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Affiliation(s)
- Matteo Scampa
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Vladimir Mégevand
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
- Department of Plastic surgery, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, United Kingdom
| | - Jérôme Martineau
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Daniel F. Kalbermatten
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Carlo M. Oranges
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
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Russell J, Breik O, Borgna SC, Volker G, Pateman K, Batstone M. Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series. Int J Oral Maxillofac Surg 2024; 53:275-281. [PMID: 37858382 DOI: 10.1016/j.ijom.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.
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Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - O Breik
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S C Borgna
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G Volker
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - K Pateman
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Su YXR, Ganry L, Ozturk C, Lohman R, Al Afif A, McSpadden R, Frias V, Pu JJ. Fibula Flap Reconstruction for the Mandible: Why It Is Still the Workhorse? Atlas Oral Maxillofac Surg Clin North Am 2023; 31:121-127. [PMID: 37500195 DOI: 10.1016/j.cxom.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Yu-Xiong Richard Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.
| | - Laurent Ganry
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Can Ozturk
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Rob Lohman
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ayham Al Afif
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ryan McSpadden
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Vladimir Frias
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jane Jingya Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
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Kumar L, Verma A, Pal US, Mattoo K, Algarni YA, Bin Hassan SA, Baba SM, Jeri SY, Khateeb SU. Influence of Prosthodontic Rehabilitation Using Zygomatic Implants in Covid 19 Related Mucormycosis (Rhino-Orbital-Cerebral) Maxillectomy Patients Upon Post-Operative Stress, Anxiety and Functional Impairment: A Prospective Cohort Study. Clin Interv Aging 2023; 18:1201-1219. [PMID: 37547381 PMCID: PMC10404046 DOI: 10.2147/cia.s412625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose To determine the influence of prosthodontic rehabilitation using zygomatic implants in partial maxillectomy upon post-operative stress, anxiety and functional impairment, due to covid 19 associated rhino-orbital-cerebral mucormycosis (ROCM). Patients and Methods Twenty maxillectomy patients fulfilling study criterion, received zygomatic implants (ZI) (quad zygoma) (ZDI Simpladent, Switzerland) retained/supported complete maxillary denture. Assessment of stress, anxiety, masticatory performance and speech were determined using diurnal salivary cortisol level, Appearance Anxiety Inventory, multiple sieve technique and auditory perception analysis, respectively. Data were recorded at 6 different stages of rehabilitation (after maxillectomy, implant placement, and after prosthesis delivery (1 week, 1 month, 6 months and 1 year)). Demographic data were expressed as frequency distribution, while mean values were used to find differences between various rehabilitation stages using Friedman and chi-square test with statistical significance value at p < 0.05. Results Average daily salivary cortisol levels declined from post maxillectomy (22.80 ± 0.902) to 1 year after prosthesis wearing (8.65 ± 0.985), indicating stress reduction after ZI rehabilitation. Mean scores for appearance anxiety reduced from pre-prosthetic rehabilitation (27.350 ± 3.030) to 1 year (8.950 ± 0.887) following prosthesis wearing. Functional parameters for mastication and speech also improved significantly during the course of rehabilitation. All differences between pre-prosthetic to 1-year stage after prosthesis wearing were found to be statistically significant at p < 0.05. Conclusion Post ROCM maxillectomy cases after prosthetic rehabilitation using zygomatic implants showed significant improvement in the psychological (stress and anxiety) as well as function (mastication and speech) characteristics. Rehabilitation post ROCM maxillectomy with the present approach of fixed prosthesis using zygomatic implants mitigates deficient mastication and speech. It also impacts positively on patient psychology by decreasing stress and anxiety.
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Affiliation(s)
- Lakshya Kumar
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Aditi Verma
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Uma Shanker Pal
- Department of Oral and Maxillofacial Surgery, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Khurshid Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia
| | - Youssef Abdullah Algarni
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Saeed Awod Bin Hassan
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Sumaya Yousuf Jeri
- Department of Orthodontics and Dentofacial Orthopedics, I.T.S Centre for Dental Studies and Research, Chaudhary Charan Singh University, Ghaziabad, Uttar Pradesh, 201206, India
| | - Shafait Ullah Khateeb
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
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Russell J, Volker G, McGarvey D, Sharpe C, Breik O, Borgna SC, Pateman K, Batstone M. An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series. Head Neck 2023; 45:398-408. [PMID: 36437486 PMCID: PMC10098479 DOI: 10.1002/hed.27254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites. METHODS A single-site, prospective cohort clinical research study was conducted. Sixty-four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre-operatively, and again >12 months post-operatively. RESULTS There was a significant reduction post-operatively in assessment tool scores compared to the pre-operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post-operatively compared to males. CONCLUSIONS The fibula, scapula, and DCIA donor sites are associated with reduced objective function post-operatively compared to patient's pre-operative baseline. The implications are least pronounced for the fibula.
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Affiliation(s)
- Joshua Russell
- Faculty of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Glen Volker
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Declan McGarvey
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Catherine Sharpe
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Omar Breik
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Scott C. Borgna
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Kelsey Pateman
- The University of QueenslandSchool of DentistryHerstonQueenslandAustralia
| | - Martin Batstone
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
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van Baar GJC, Lodders JN, Chhangur C, Leeuwrik L, Forouzanfar T, Liberton NPTJ, Berkhout WER, Winters HAH, Leusink FKJ. The Amsterdam UMC protocol for computer-assisted mandibular and maxillary reconstruction; A cadaveric study. Oral Oncol 2022; 133:106050. [PMID: 35914442 DOI: 10.1016/j.oraloncology.2022.106050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/12/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In this cadaveric study, the accuracy of CAS guided mandibular and maxillary reconstruction including immediate dental implant placement in different Brown defect classes is assessed. MATERIALS AND METHODS The virtual planning and surgical procedure was conducted according to a newly proposed Amsterdam UMC reconstruction protocol. Postoperative evaluation was performed according to a previously proposed evaluation guideline. RESULTS Fourteen mandibular and 6 maxillary reconstructions were performed. Average mandibular angle deviations were 1.52°±1.32, 1.85°±1.58, 1.37°±1.09, 1.78°±1.37, 2.43°±1.52 and 2.83°±2.37, respectively for the left and right axial angles, left and right coronal angles and left and right sagittal angles. A total of 62 dental implants were placed in neomandibles with an average dXYZ values of 3.68 ± 2.21 mm and 16 in neomaxillas with an average dXYZ values of 3.24 ± 1.7 mm. CONCLUSION Promising levels of accuracy were achieved for all mandibular angles. Dental implant positions approached the preoperative preferred positions well, within the margin to manufacture prosthetic devices.
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Affiliation(s)
- Gustaaf J C van Baar
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Johannes N Lodders
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chayenne Chhangur
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lars Leeuwrik
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Niels P T J Liberton
- Department of Medical Technology, 3D Innovation Lab, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - W Erwin R Berkhout
- Department of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank K J Leusink
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Iliac crest free flap: a reappraisal of indications and donor site complications. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Shavlokhova V, Goeppert B, Gaida MM, Saravi B, Weichel F, Vollmer A, Vollmer M, Freudlsperger C, Mertens C, Hoffmann J. Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147370. [PMID: 34299820 PMCID: PMC8304219 DOI: 10.3390/ijerph18147370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022]
Abstract
Background: Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction. Case presentation: We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap. Conclusions: There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
- Correspondence:
| | - Benjamin Goeppert
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
| | - Matthias M. Gaida
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (B.G.); (M.M.G.)
- Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg-Universität Mainz, 55131 Mainz, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Frederic Weichel
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Andreas Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Michael Vollmer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Christian Mertens
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (F.W.); (A.V.); (M.V.); (C.F.); (C.M.); (J.H.)
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Garajei A, Kheradmand AA, Miri SR, Emami A. A retrospective study on mandibular reconstruction using iliac crest free flap. Ann Med Surg (Lond) 2021; 66:102354. [PMID: 34026108 PMCID: PMC8121997 DOI: 10.1016/j.amsu.2021.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the availability, success rate and complications of microvascular iliac crest free flap for reconstruction of mandibular segmental defects. METHODS In this retrospective-descriptive study, we report patients who had undergone segmental mandibular resection for pathologic lesions and received reconstruction with iliac crest microvascular free flap between 2016 and 2019. Clinical and demographic data of all the cases were collected. Success was regarded as complete consolidation of the bone graft in panoramic radiograph. Postoperative complications were defined as major or minor based on the need for intervention. T-test, Kolomogorov_Smirnov, and multivariate analysis were used and the p-value<0.05 was considered to be statistically significant. RESULTS Of all 30 patients, 16 were women and 14 were men with an average age of 27.2 years (range 14-40). Patients were followed for 12-60 month (mean: 38.4). One flap was lost due to unsalvageable venous thrombosis. Six other cases had post-op complications while smoking and diabetes were associated with more complications (P = 0.036). Twenty-three patients received primary reconstruction which was more successful than secondary ones (P = 0.003). Osteogenic sarcoma was associated with greater risk of complications (P < 0.01). CONCLUSIONS The results of this study suggest that iliac crest microvascular free flap serves as a promising option for the reconstruction of mandibular defects, providing excellent contour and acceptable success rate with low donor site morbidity. Future studies will focus on the role of systemic diseases in post-op complications and flap failures.
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Affiliation(s)
- Ata Garajei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A. Kheradmand
- The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Head and Neck Surgical Oncology and Reconstructive Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Roohollah Miri
- The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Emami
- Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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11
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Lim KA, Lin CH, Lin CH. A 19-Year Experience With Clavicular Defects: An Algorithm for Flap Selection and Surgical Outcomes. Ann Plast Surg 2021; 86:562-567. [PMID: 33939654 DOI: 10.1097/sap.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clavicle contributes to the stability and functional integrity of the shoulder. Clavicle bone defects are uncommon, and the strategy for their management is variable. METHOD Six patients presented with clavicle bone defects. The causes were as follows: traumatic defects (2 patients), electric injury (1 patient), osteoradionecrosis (2 patients), and nonunion (1 patient). One patient had upper limb palsy for 40 years, and another had posttraumatic shoulder function impairment. A pedicled pectoralis major myocutaneous flap was used for the patient with a dysfunctional limb, and 5 bone flaps (3 free fibular flaps, 1 free iliac flap, and 1 pedicled rib flap) were used for reconstruction in the other patients. RESULT All flaps (2 pedicled flaps and 4 free flaps) were successfully used for wound repair; the pedicled rib flap demonstrated partial marginal necrosis, and the free fibular flap required reexploration for venous kinking. Five functionally impaired upper limbs showed functional improvements postoperatively. CONCLUSION For functionless composite clavicles and soft tissue defects, a soft tissue flap will be required for wound repair. A bone flap, especially a fibular flap, is required for the upper limb to show functional recovery. The variety of flaps will be planned according to the defect size comparison between the bone and soft tissue, and ipsilateral upper limb function, and a proposed algorithm will be discussed.
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Zhang C, Zeng Y, Zhou L, Tang X. The application of chimeric deep circumflex iliac artery perforator flap for oromandibular reconstruction: A case report. Medicine (Baltimore) 2021; 100:e25458. [PMID: 33832155 PMCID: PMC8036069 DOI: 10.1097/md.0000000000025458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The free fibular flap is considered the gold standard, particularly for a mandibular defect combined with a significant soft tissue defect. However, the fibular flap has the disadvantages of a lack of height for postoperative dental restoration and donor site skin graft if the skin paddle is wider than 5 cm. The larger bone and soft tissue defects tend to be reconstructed using either a scapula or a combination of iliac artery and radial free flap. Few cases involving reconstruction using chimeric deep circumflex iliac artery perforator flap (DCIAPF) for mandibular defect combined with more significant soft tissue defects have been reported due to perforator variations. We successfully performed oromandibular reconstruction using chimeric DCIAPF. PATIENT CONCERNS A 56-year-old male patient was admitted due to "constant pain in the gradually enlarged right lower gingival mass since the previous four months." The patient had no other obvious symptoms, and no history of diabetes or hypertension was reported. The patient reported long-term smoking and drinking habits. DIAGNOSES Computed tomography (CT) revealed a neoplasm in the right buccal space, which is primarily considered a malignancy. The pathological results of a gingival mass biopsy presented squamous cell carcinoma. INTERVENTIONS No operative contraindications were confirmed after regular tests and examinations were undertaken. The patient underwent a primary extent resection of a 6-cm-long mandible, including mass and suprascapulohyoid neck dissection. The oromandibular defects were then reconstructed with chimeric DCIAPF, simultaneously using the iliac crest bone flap to repair the mandibular lateral segment defect and the skin paddle to repair the intraoral soft tissue defect of 5 × 10 cm. OUTCOMES The total operating time was five and half hours and blood loss was approximately 500 ml. The operation was successful, with no infections or flap loss. Six months postoperatively, CT showed that the iliac crest bone had connected to the alveolar bone of the mandible. The height of the iliac crest bone was sufficient for postoperative dental restoration. The patient healed without obvious complications and no tumor recurrence. LESSONS Chimeric DCIAPF is an excellent option for mandibular angle or body segment defects combined with significant soft tissue defects.
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Affiliation(s)
| | - Yi Zeng
- Department of Clinical Laboratory, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China
| | - Lian Zhou
- Department of Head and Neck Cancer Center
| | - Xi Tang
- Department of Head and Neck Cancer Center
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Gu Y, Ma H, Shujaat S, Orhan K, Coucke W, Amoli MS, Bila M, Politis C, Jacobs R. Donor- and recipient-site morbidity of vascularized fibular and iliac flaps for mandibular reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 74:1470-1479. [PMID: 33903068 DOI: 10.1016/j.bjps.2021.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
The aim of this article is to evaluate the early and late morbidities of the donor- and recipient-site in patients undergoing mandibular reconstruction using either vascularized fibular flap (VFF) or vascularized iliac flap (VIF). Electronic databases, including PubMed, Web of Science, Cochrane Central and Embase, were explored for literature published until October 2020. A total of twenty-four articles reporting complications following mandibular reconstruction surgery with follow-up periods ranging from six to 63 months were selected based on the exclusion criteria. For each research, the JBI Critical Assessment Tool and the ROBINS-I Tool were used to analyze the methodological quality and the risk of bias. A single-arm meta-analysis was performed to have a synthesized analysis of the donor- and recipient-site early and late morbidities. Results showed that the early morbidities in VFF group ranged from 3% to 12%, and the late morbidities in VFF group ranged from 5% to 67%. In VIF group, the early morbidities ranged from 3% to 16%, and the donor-site late morbidities ranged from 6% to 43%. Complications with the top three morbidities in the VFF group were: chronic sensory disturbances at the donor-site (67%), malocclusion (22%) and chronic lower limb weakness (20%); and in the VIF group were: chronic sensory disturbances at the donor-site (43%), chronic pain at the donor-site (26%), chronic gait disturbance (20%). Further controlled clinical trials are needed to assess the long-term outcome of VFF or VIF grafting.
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Affiliation(s)
- Yifei Gu
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium.
| | - Hongyang Ma
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium
| | - Kaan Orhan
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium; Ankara University Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara (00680), Turkey
| | - Wim Coucke
- Freelance Statistician, Heverlee (3001), Belgium
| | - Mehdi Salar Amoli
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium
| | - Michel Bila
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven (3000), Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Hilven PH, Vranckx JJ. The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era. J Reconstr Microsurg 2021; 37:671-681. [PMID: 33634440 DOI: 10.1055/s-0041-1724129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The iliac crest bone flap (ICBF), based on the deep circumflex iliac artery, has a bad reputation regarding donor site morbidity. However, the ICBF has an ideal curvature and shape for occlusion-based hemimandibular reconstructions with rapid dental rehabilitation and for vertical class III maxillary reconstructions that require bony support and muscular bulk to fill cavities and to provide intraoral lining. Is this notorious donor site reputation still valid with modern flap procurement using computer aided design/computer aided manufacturing (CAD/CAM) and recipient-site closure techniques? MATERIALS AND METHODS We performed a literature search of the public databases PubMed, Cochrane, Google Scholar, and Web of Science for papers using mesh keywords related to donor site morbidity of the ICBF. We report three illustrative case reports using our current protocols for oncologic bony resection and reconstruction, using in-house CAD/CAM and three-dimensional printing to procure a tight-fit ICBF and minimizing donor site morbidity. RESULTS We found 191 articles in the PubMed database of which we considered 176 nonrelevant. Cochrane Library and Google Scholar database searches resulted in the inclusion of 11 additional papers. The second search resulted in 172 articles of which we used five after excluding nonrelevant papers. Accurate preoperative (CAD/CAM) planning, preservation of the anterior superior iliac spine (ASIS), and paying attention to thoroughly donor site closure make the ICBF a very valuable option for accurate maxillofacial reconstructions with very acceptable comorbidities. This corresponds with our clinical findings. CONCLUSION Dogma never is a good teacher; it remains elementary that routine "knowledge" is (re)questioned. Donor site morbidity of the ICBF is comparable to other bone flaps. The shape and bone stock of the ICBF is ideal and often may be first choice. In combination with CAD/CAM planning, the ICBF is an excellent option for specific maxillofacial reconstructions.
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Affiliation(s)
- Paulien H Hilven
- Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
| | - Jan J Vranckx
- Department of Plastic and Reconstructive Surgery, KU Leuven University Hospitals, Leuven, Belgium
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Sweeny L, Mayland E, Swendseid BP, Curry JM, Kejner AE, Thomas CM, Kain JJ, Cannady SB, Tasche K, Rosenthal EL, DiLeo M, Luginbuhl AJ, Theeuwen H, Sarwary JR, Petrisor D, Wax MK. Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life. Otolaryngol Head Neck Surg 2021; 165:636-646. [PMID: 33618563 DOI: 10.1177/0194599821990682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. STUDY DESIGN Retrospective multi-institutional review. SETTING Tertiary care centers. METHODS Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. RESULTS Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). CONCLUSION The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
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Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Erica Mayland
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Brian P Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Carissa M Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steve B Cannady
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kendall Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Michael DiLeo
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Juliana R Sarwary
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel Petrisor
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark K Wax
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Ma H, Van Dessel J, Shujaat S, Bila M, Gu Y, Sun Y, Politis C, Jacobs R. Long-term functional outcomes of vascularized fibular and iliac flap for mandibular reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2020; 74:247-258. [PMID: 33277215 DOI: 10.1016/j.bjps.2020.10.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/10/2020] [Accepted: 10/24/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To date, there is a lack of evidence related to the long-term evaluation of recipient-site functional outcomes following mandibular reconstruction with vascularized bone grafts. Therefore, the aim of this systematic review and meta-analysis was to evaluate the long-term recipient-site functional outcomes in oral oncology patients who require mandibular reconstruction with either vascularized fibular flap (VFF) or vascularized iliac flap (VIF). METHODS An extensive electronic search was conducted in PubMed, Web of Science, Cochrane, and Embase databases for identifying articles published until April 2020. All papers were dual screened for eligibility in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. The risk of bias was assessed using the MINORS tool. A meta-analysis of functional outcome parameters was performed to estimate single incidence rates. RESULTS A total of 257 patients with a mean follow-up period of 38.6 ± 19.5 months were included in this meta-analysis, where 174 patients underwent VFF reconstruction and 83 patients involved reconstruction with VIF. The functional outcomes in patients reconstructed with VIF showed improved scoring for mastication, deglutition, diet, and speech. Speech showed highest score among all functional parameters, whereas, mastication was the most poorly recovered parameter in relation to reconstruction with both flaps. No significant difference in functional outcomes was observed between both flaps. CONCLUSION Current evidence seems to indicate that VIF offers improved long-term recipient-site functional outcomes. Yet, considering a high level of data heterogeneity in published studies, future long-term standardized comparative studies should be conducted.
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Affiliation(s)
- Hongyang Ma
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium.
| | - Jeroen Van Dessel
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Michel Bila
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Yifei Gu
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Yi Sun
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Shanti RM, Choi J, Thomas WW, Sheth NP, Cannady SB. Reconstruction of Through-and-Through Composite Segmental Mandibulectomy Defect in a Patient With a Dominant Peroneal Artery Using an Anterior Lateral Thigh Osteomyocutaneous Free Flap: A Case Report and Description of Flap. J Oral Maxillofac Surg 2020; 78:1436.e1-1436.e7. [DOI: 10.1016/j.joms.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
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Bettini G, Saia G, Valsecchi S, Bedogni G, Sandi A, Bedogni A. Three-dimensional CAD/CAM reconstruction of the iliac bone following DCIA composite flap harvest. Int J Oral Maxillofac Surg 2020; 50:32-37. [PMID: 32591226 DOI: 10.1016/j.ijom.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/02/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
This article reports a new technique to restore iliac bone integrity with a customized titanium device designed by CAD/CAM, in patients undergoing deep circumflex iliac artery (DCIA) composite flap harvest. Eight consecutive patients who underwent the repair of major head and neck defects with DCIA flaps were enrolled retrospectively. Computed tomography scans of the pelvis were obtained preoperatively. Starting from DICOM data, each personalized device was designed using modelling software and was finally made by additive manufacturing using a laser sintering machine. After surgery, the patients were followed up at 3-month intervals to evaluate the incidence of complications and the long-term outcome at the donor site. A subcutaneous seroma developed in one patient and an inguinal skin burn occurred in another. At a median follow-up of 12 months, the patients did not report pain, or any gait or sensory disturbance at the donor site. There was no occurrence of bulging, herniation, or instability or inflammation near the device for the entire follow-up duration. All patients were satisfied with the aesthetic result. In conclusion, reconstruction of the iliac bone with a customized device is safe and well tolerated. We recommend use of this device in patients deemed at high risk of herniation. Further studies are needed to confirm the stability of the device in the long term.
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Affiliation(s)
- G Bettini
- Department of Neuroscience, Unit of Maxillofacial Surgery, University of Padua, Padua, Italy; Regional Centre for the Prevention, Diagnosis and Treatment of Medication and Radiation-related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy.
| | - G Saia
- Department of Neuroscience, Unit of Maxillofacial Surgery, University of Padua, Padua, Italy
| | - S Valsecchi
- Maxillofacial Surgery Unit, "S. Anna" Hospital, Como, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Centre, Basovizza, Trieste, Italy; Department of Medicine, University of Padua, Padua, Italy
| | - A Sandi
- Sintac s.r.l., Biomedical Engineering, Trento, Italy
| | - A Bedogni
- Department of Neuroscience, Unit of Maxillofacial Surgery, University of Padua, Padua, Italy; Regional Centre for the Prevention, Diagnosis and Treatment of Medication and Radiation-related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
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Jaloux C, Bettex Q, Levadoux M, Cerlier A, Iniesta A, Legre R, Mayoly A, Gay A. Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union. J Plast Reconstr Aesthet Surg 2020; 73:1232-1238. [PMID: 32414702 DOI: 10.1016/j.bjps.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/19/2022]
Abstract
Clavicle non-union is a challenging problem. Open reduction with internal fixation and autologous bone grafting is usually the first line treatment. In case of failure, the medial femoral condyle corticoperiosteal flap in association with a non-vascularized bone graft is one of the therapeutic options, which is well adapted to the clavicle anatomical characteristics. We performed a retrospective study of all patients treated with this technique in our department. Between 2014 and 2017, five patients with recalcitrant post traumatic clavicle non-unions received this surgical treatment. The average nonunion time period was 50.2 month (range 10 to 108 months), and the mean defect length was 3.4 cm (between 2 and 5 cm), defects were all located in the medial third of the clavicle Three patients achieved full consolidation with an average time of consolidation of 8,7 months (range 6 to12 months). Patients with radiological consolidation had better functional improvement and pain reduction with an average DASH score improved from 53,6 before surgery to 19,6 after consolidation (at the last follow up visit). There was one donor site complications (hematoma). The medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft is a good option for the management of recalcitrant clavicle non-union, especially when the bone defect is small.
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Affiliation(s)
- Charlotte Jaloux
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France.
| | - Quentin Bettex
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
| | - Michel Levadoux
- Department of hand, upper limb and peripheral nerves surgery - Clinique Saint Roch, Toulon, France
| | - Alexandre Cerlier
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
| | - Aurélie Iniesta
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
| | - Régis Legre
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
| | - Alice Mayoly
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
| | - André Gay
- Department of Hand Surgery and Plastic and reconstructive surgery of the limbs - La Timone University Hospital - Assistance Publique Hôpitaux de Marseille, France
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Shokri T, Wang W, Cohn JE, Kadakia S, Ducic Y. Premaxillary Deficiency: Techniques in Augmentation and Reconstruction. Semin Plast Surg 2020; 34:92-98. [PMID: 32390776 DOI: 10.1055/s-0040-1709175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.
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Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Zeman-Kuhnert K, Gaggl A, Brandtner C, Wittig-Draenert A, Bottini G, Wittig J. Donor site morbidity after microvascular medial femoral condylar flap procurement for facial reconstruction. Int J Oral Maxillofac Surg 2020; 49:569-575. [DOI: 10.1016/j.ijom.2019.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 11/20/2019] [Indexed: 11/16/2022]
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Do Functional Scores of Flap Donor Sites Recover After Reconstruction of Segmental Jaw Defects? J Oral Maxillofac Surg 2019; 78:851.e1-851.e7. [PMID: 31911064 DOI: 10.1016/j.joms.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The potential for donor-site morbidity in major maxillofacial reconstruction remains a concern. The purpose of this study was to compare the outcome of donor-site morbidity of deep circumflex iliac artery (DCIA) and scapula free flaps after radical treatment of the jaw and flap reconstruction. PATIENTS AND METHODS We implemented a prospective cohort study design. Patients requiring segmental resection for benign pathology underwent reconstruction with either DCIA or scapula free flaps. The primary predictor variable was the use of DCIA versus scapula free flaps. The primary outcome variables were changes in orthopedic functional scores for both donor sites. The secondary outcome variable was neurosensory recovery at the recipient site. RESULTS We included 8 patients in this study, comprising 3 women (38%) and 5 men (62%). Orthopedic scores were assigned preoperatively (T0) and at follow-up appointments at 1 to 3 months postoperatively (T1) and 6 to 12 months postoperatively (T2). In patients with DCIA flaps, a significant reduction (P = .0096) in the Larson I score between examination time points T0 and T1 was found. The score then improved on the operated side between T1 and T2 by an average of 29 points and showed no significant difference compared with the T0 level (P = .68). Patients with a scapular graft showed a significant reduction (P = .004) in the Constant-Murley score on the operated side between T0 and T1. The Constant-Murley score again improved significantly (P = .0136) between T1 and T2. Most of the patients (n = 7, 88%) had a neurologically unremarkable local situation of the recipient site at T0. At T1, 1 patient had level A (mild) neurosensory disorder and 1 had level B (moderate). At T2, all patients' initial neurologic scores were restored. CONCLUSIONS The donor-site morbidity associated with DCIA and scapula flap reconstruction is a short-term condition and returns to baseline by 3 to 6 months postoperatively.
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Lei P, Du W, Liu H, Wu P, Zhou Z, Yu F, Qing L, Pan D, Liu R, Zeng L, Cao Z, Ou Q, Tang J. Free vascularized iliac bone flap based on deep circumflex iliac vessels graft for the treatment of osteonecrosis of femoral head. J Orthop Surg Res 2019; 14:397. [PMID: 31779640 PMCID: PMC6883673 DOI: 10.1186/s13018-019-1440-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults. METHODS Eighteen patients (19 hips) undergoing ONFH were included from January 2016 to May 2017. After the debridement of the necrotic bones, the contralateral vascularized iliac bone flap was designed and harvested before grafting, in which the deep circumflex iliac vessels and the transverse branch (or ascending branch) of the lateral circumflex femoral artery and their accompanying veins were anastomosed. X-ray was obtained at 1, 3, 6, 9, and 12 months respectively for evaluation of the bone flap healing. Hip function was evaluated with Harris hip score at 18 months postoperatively. RESULTS None of the patients is lost to follow-up. All the hips healed well except for four complications: one patient developed superficial wound infection, one patient had subcutaneous hematoma, and two patients developed anterolateral femoral cutaneous nerve injury. X-ray films at 12 months showed improvement in 13 hips (68.4%), five hips (26.3%) were unchanged, and one femoral head collapse with conversion to total hip arthroplasty (THA) at 14 months postoperatively (5.3%). Postoperative mean Harris hip scores were significantly improved compared to the preoperative results (P < 0.05). CONCLUSION Free vascularized iliac bone flap based on deep circumflex iliac vessels graft is an acceptable treatment option for young adult ONFH in mid-late stage with low conversion to THA rate at short-term follow-up.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Wei Du
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hao Liu
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhengbing Zhou
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Fang Yu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Liming Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Rui Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Lei Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zheming Cao
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Qifeng Ou
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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Fisher BM, Batstone MD. Pregnancy and childbirth after an iliac crest free flap. Br J Oral Maxillofac Surg 2019; 57:1148-1149. [PMID: 31594718 DOI: 10.1016/j.bjoms.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
We report two successful pregnancies and vaginal deliveries by patients who had previously had deep circumflex iliac artery free flaps that had been harvested for reconstruction in the head and neck.
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Affiliation(s)
- B M Fisher
- Oral & Maxillofacial Surgery Royal Brisbane & Women's Hospital, Butterfield Street & Bowen Bridge Road Herston, QLD, 4029, Australia.
| | - M D Batstone
- Oral & Maxillofacial Surgery Royal Brisbane & Women's Hospital, Butterfield Street & Bowen Bridge Road Herston, QLD, 4029, Australia
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25
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Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options. Arch Plast Surg 2018; 45:495-503. [PMID: 30466228 PMCID: PMC6258970 DOI: 10.5999/aps.2017.01592] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/15/2018] [Indexed: 11/08/2022] Open
Abstract
With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.
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Hadouiri N, Feuvrier D, Pauchot J, Decavel P, Sagawa Y. Donor site morbidity after vascularized fibula free flap: gait analysis during prolonged walk conditions. Int J Oral Maxillofac Surg 2018; 47:309-315. [PMID: 29100670 DOI: 10.1016/j.ijom.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/31/2017] [Accepted: 10/12/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine the effect of vascularized fibula free flap (VFFF) harvest on gait variables during the six-minute walk test (6MWT). Eleven patients who had undergone VFFF harvest and 11 healthy peers participated in this case-control study. The main evaluation consisted of the collection of gait variables using the GAITRite system during three periods of the 6MWT: beginning (0-1min), middle (2:30-3:30min), and end (5-6min). The 6MWT was significantly shorter in the VFFF group than in the reference group (-31%, P<0.001). Most gait variables differed significantly between the groups for each period (P-value range 0.04-0.0004), including toe in/out on the operated side (P-value range 0.005-0.01). The increase in toe in/out on the operated side suggests a functional modification caused by an imbalance of the agonist-antagonist muscles. On comparison of the different periods, gait velocity decreased between the beginning and middle periods and increased between the middle and end periods in both groups. However, a significantly lower velocity between the beginning and end periods was found only for the VFFF group (P=0.026), suggesting an alteration in physical management. In conclusion, these results suggest that VFFF harvesting could alter gait and joint integrity.
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Affiliation(s)
- N Hadouiri
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
| | - D Feuvrier
- Orthopaedic, Traumatology, Plastic, Reconstructive and Hand Surgery Unit, University Hospital of Besançon, Besançon, France; Anatomy Laboratory, UFR SMP, University of Franche-Comte, Besançon, France
| | - J Pauchot
- Orthopaedic, Traumatology, Plastic, Reconstructive and Hand Surgery Unit, University Hospital of Besançon, Besançon, France
| | - P Decavel
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
| | - Y Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.
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27
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Zheng L, Lv X, Zhang J, Zhang J, Zhang Y, Cai Z, Liu S. Deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction. J Craniomaxillofac Surg 2018; 46:1263-1267. [DOI: 10.1016/j.jcms.2018.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/05/2018] [Accepted: 04/23/2018] [Indexed: 11/26/2022] Open
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Subjective morbidity following fibular free flap reconstruction in head and neck cancer patients. The Journal of Laryngology & Otology 2018; 132:729-733. [PMID: 30039779 DOI: 10.1017/s0022215118001068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to evaluate the presence of subjective post-operative donor site morbidity after fibula free flap reconstruction in head and neck cancer patients, utilising three validated instruments: the 36-item Short Form Health Survey, the Short Musculoskeletal Function Assessment questionnaire and the Lower Limb Core Scale. METHODS In this retrospective study, all head and neck cancer patients who underwent fibula free flap reconstruction between January 2009 and July 2014 were identified. All questionnaires and their respective subcomponents were scored. RESULTS Twenty-one cases were included. Patients were found to have a higher Short Musculoskeletal Function Assessment bothersome index (22.42 vs 13.77, p = 0.03), a lower Short Form 36 Health Survey Physical Component Summary score (42.44 vs 50, p < 0.01) and a decreased Lower Limb Core Scale score (47.08 vs 90.52, p < 0.01), compared to US population norms. The Short Form 36 Health Survey Mental Component Summary scores and Short Musculoskeletal Function Assessment function index failed to demonstrate significant differences. Gender affected overall disability. CONCLUSION In this study, significant long-term disability was demonstrated after fibular flap reconstruction, as measured by the Lower Limb Core Scale.
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29
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Rogers SN, Barber B. Using PROMs to guide patients and practitioners through the head and neck cancer journey. PATIENT-RELATED OUTCOME MEASURES 2017; 8:133-142. [PMID: 29184455 PMCID: PMC5687779 DOI: 10.2147/prom.s129012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The measurement of patient-reported outcome measures (PROMs) following head and neck cancer (HNC) has the capacity to substantially enhance the care of patients and their care-givers following the diagnosis and treatment of HNC. Literature concerning PROMs has increased exponentially in the past 2 decades, producing a vast array of data upon which the multidisciplinary team can reflect. For this review, “Handle On QOL” has been used as a source of references to illustrate the points raised. PROMs are contextualized by considering the clinically-distinct key stages that cancer patients endure: diagnosis, treatment, acute toxicity, early recovery, late effects, recurrence, and palliation. The PROMs are considered in six main categories: 1) those addressing cornucopia of issues not specific to cancer; 2) those addressing issues common to all cancers; 3) questionnaires with items specific to HNC; 4) questionnaires that focus on a particular aspect of head and neck function; 5) those measuring psychological concerns, such as depression, anxiety, or self-esteem; and 6) item prompt lists. Potential benefits of PROMs in clinical practice are discussed, as are barriers to use. The way forward in integrating PROMs into routine HNC care is discussed with an emphasis on information technology.
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Affiliation(s)
- Simon N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK.,Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - Brittany Barber
- Head and Neck Department, Icahn School of Medicine at Mount Sinai (MSSM), New York, NY, USA
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30
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Connolly TM, Sweeny L, Greene B, Morlandt A, Carroll WR, Rosenthal EL. Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life. Microsurgery 2017; 37:752-762. [PMID: 28843005 DOI: 10.1002/micr.30201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 05/23/2017] [Accepted: 06/23/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. METHODS Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre. Donor site complications and acute and long-term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW-QOL) Questionnaire. RESULTS A total of 68 midface defects were reconstructed using the OC-RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC-RFFF repair had mean scores for UW-QOL outcomes higher than published rates of obturator quality of life. CONCLUSION The OC-RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR-QOL, are acceptable.
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Affiliation(s)
- Timothy M Connolly
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - Larissa Sweeny
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benjamin Greene
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - William R Carroll
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eben L Rosenthal
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California
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31
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Cobb R, Muscat K, Cascarini L, Fry A. Fibrin sealant (Tisseel™) for mesh fixation in repair of the deep circumflex iliac artery (DCIA) free flap donor site. Br J Oral Maxillofac Surg 2017; 55:748-749. [PMID: 28576300 DOI: 10.1016/j.bjoms.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
- R Cobb
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT.
| | - K Muscat
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
| | - L Cascarini
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
| | - A Fry
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
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Schardt C, Schmid A, Bodem J, Krisam J, Hoffmann J, Mertens C. Donor site morbidity and quality of life after microvascular head and neck reconstruction with free fibula and deep-circumflex iliac artery flaps. J Craniomaxillofac Surg 2017; 45:304-311. [DOI: 10.1016/j.jcms.2016.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/10/2016] [Accepted: 11/22/2016] [Indexed: 12/31/2022] Open
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33
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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Iliolumbar artery: a useful pedicle for the iliac crest free flap in maxillofacial reconstruction. Br J Oral Maxillofac Surg 2017; 55:270-273. [PMID: 28089170 DOI: 10.1016/j.bjoms.2016.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/23/2016] [Indexed: 11/22/2022]
Abstract
The iliac crest free flap is commonly used in maxillofacial reconstruction, and is typically supplied by the deep circumflex iliac artery (DCIA). However, the iliolumbar artery is an alternative blood supply that can potentially be used in such reconstructions. We describe the anatomy of the iliolumbar artery and review publications about its clinical use. We raised four cadaveric iliac crest free flaps using both the DCIA and the iliolumbar artery to illustrate its use in reconstructing maxillofacial defects. It provided a longer pedicle for microvascular anastomosis than the DCIA, was more versatile in orientation of the flap, and allowed the chance of anastomosing both pedicles to "super-charge" the flap's blood supply. We describe a patient in whom this flap was used successfully, which shows that the iliolumbar artery is a suitable pedicle to augment (or replace) the DCIA in an iliac crest free flap.
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Kumar BP, Venkatesh V, Kumar KAJ, Yadav BY, Mohan SR. Mandibular Reconstruction: Overview. J Maxillofac Oral Surg 2016; 15:425-441. [PMID: 27833334 PMCID: PMC5083680 DOI: 10.1007/s12663-015-0766-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/28/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. PURPOSE This article reviews the history of oromandibular reconstruction, biomechanics of mandible, summarizes the reconstruction options available for mandible with defect classification, goals in reconstruction, the various donor sites, current reconstructive options, dental rehabilitation and persistent associated problems. SUMMARY Oromandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts and current reconstructive options. The ideal reconstruction would provide a solid arch to articulate with the upper jaw, restoring swallowing speech, mastication, and esthetics. Autogenous vascularized bone grafts in combination with microsurgical techniques have revolutionized mandibular reconstruction in oral cancer surgery. Current trends in mandibular reconstruction aim to achieve reestablishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive autogenous graft procurement. However the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection, timing of surgery and method of reconstruction.
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Affiliation(s)
- Batchu Pavan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - V. Venkatesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - K. A. Jeevan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - B. Yashwanth Yadav
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - S. Ram Mohan
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
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Brown J, Schache A, Butterworth C. Liverpool Opinion on Unfavorable Results in Microsurgical Head and Neck Reconstruction. Clin Plast Surg 2016; 43:707-18. [DOI: 10.1016/j.cps.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap. Eur Arch Otorhinolaryngol 2016; 274:939-945. [DOI: 10.1007/s00405-016-4266-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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38
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Mohindra A, Parmar S, Praveen P, Martin T. The fat–fascia paddle only with a composite fibula flap: marked reduction in donor site morbidity. Int J Oral Maxillofac Surg 2016; 45:964-8. [DOI: 10.1016/j.ijom.2016.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/09/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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39
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Assessing the Anatomical Variability of Deep Circumflex Iliac Vessels in Harvesting of Iliac Crest-Free Flap for Mandibular Reconstruction. J Craniofac Surg 2016; 27:e320-3. [DOI: 10.1097/scs.0000000000002576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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40
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Kim HS, Kim JY, Hur H, Nam W. Herniation after deep circumflex iliac artery flap: two cases of rare complication. Maxillofac Plast Reconstr Surg 2016; 38:10. [PMID: 27054130 PMCID: PMC4766219 DOI: 10.1186/s40902-016-0055-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/09/2016] [Indexed: 11/20/2022] Open
Abstract
Herniation after harvesting of deep circumflex iliac artery (DCIA) flap is a known but not a common complication. It occurs about 2.8 to 9 % according to the literatures and can proceed to a more severe complication such as bowel obstruction. There are several factors that exacerbate the risk: surgical factors, operator factor, and patient factors. Surgical factors include large anatomical defect and denervation of related muscles. Operator factor stands for unpunctual suture technique. Patient factors represent obesity, diabetes, pulmonary disease, smoking habits, and so on. Thus, herniation might occur regardless of meticulous suture. Herein, we would like to report two cases of herniation after DCIA flap harvesting and repaired by Lichtenstein tension-free hernioplasty with literature review.
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Affiliation(s)
- Hee-Sung Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-752 Korea
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Oral Cancer Research Institute, Yonsei University College of Dentistry, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-752 Korea
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Feuvrier D, Sagawa Y, Béliard S, Pauchot J, Decavel P. Long-term donor-site morbidity after vascularized free fibula flap harvesting: Clinical and gait analysis. J Plast Reconstr Aesthet Surg 2015; 69:262-9. [PMID: 26602741 DOI: 10.1016/j.bjps.2015.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the clinical morbidity and changes in gait temporal spatial parameters after harvesting of a vascularized free fibula flap. This study included 11 patients (mean age: 52 ± 17 years) and 11 healthy controls (mean age: 50 ± 14 years). The patients were assessed between 5 and 104 months post surgery. The study consisted of a subjective functional evaluation with two validated clinical scores (Kitaoka Score and Point Evaluation System (PES) score), clinical and neurological examination of the legs, and evaluation of gait temporal spatial parameters while walking at a comfortable speed. The mean functional Kitaoka score was 78/100, and the mean PES score of 12.18 was considered average. At the time of the review, five patients had sensory disorders, two had toe deformities, and eight had pain at the donor site. The gait analysis showed that the patient's comfortable walking speed was significantly lower in comparison to that of the controls, and that stride length and cadence were reduced. In addition, most of the gait-specific parameters were significantly different. The donor leg displayed greater variability during walking. To reduce the risk of falling, this study revealed that the patients' gait pattern had changed as they took a more cautious approach during walking. Early rehabilitation is expected to help improve and/or restore the physical abilities of patients after harvesting of the vascularized free fibula flap.
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Affiliation(s)
- Damien Feuvrier
- Service chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Jean Minjoz, Besançon, France.
| | - Yoshimasa Sagawa
- Laboratoire d'Exploration Fonctionnelle Clinique du Mouvement, CHRU de Besançon, Besançon, France
| | - Samuel Béliard
- Service de Cardiologie, Angiologie, CH Louis Pasteur, Dole, France; Université de Franche Comté, EA 4267 Fonctions et Dysfonctions Epithéliales, Besançon, France
| | - Julien Pauchot
- Service chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Jean Minjoz, Besançon, France
| | - Pierre Decavel
- Laboratoire d'Exploration Fonctionnelle Clinique du Mouvement, CHRU de Besançon, Besançon, France
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Grinsell D, Catto-Smith HE. Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla. J Plast Reconstr Aesthet Surg 2015; 68:1044-53. [DOI: 10.1016/j.bjps.2015.04.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 11/16/2022]
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Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction. J Craniomaxillofac Surg 2015; 43:658-62. [DOI: 10.1016/j.jcms.2015.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/02/2015] [Accepted: 03/19/2015] [Indexed: 11/23/2022] Open
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Long-term peri-implant bone level changes of non-vascularized fibula bone grafted edentulous patients. J Craniomaxillofac Surg 2015; 43:611-5. [DOI: 10.1016/j.jcms.2015.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/19/2022] Open
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Mandibular reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison. The Journal of Laryngology & Otology 2014; 128:1034-43. [PMID: 25399527 DOI: 10.1017/s0022215114002278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages. METHODS A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes. RESULTS The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib-serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects. CONCLUSION The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.
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Quality of Life Assessment in Patients After Mandibular Resection and Free Fibula Flap Reconstruction. J Oral Maxillofac Surg 2014; 72:1616-26. [DOI: 10.1016/j.joms.2014.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/20/2022]
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Abstract
The traumatized hand often has soft tissue loss requiring flap reconstruction. Before proceeding with flap selection, the need for future refinement and secondary surgery should be taken into consideration. Although muscle flaps may offer better contour, fasciocutaneous flaps allow easier secondary flap elevation. After the initial flap reconstruction, indications for secondary procedures may be managed according to tissue type: bone, joint, tendon, nerve, and soft tissue.
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Affiliation(s)
- Grace J Chiou
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Stanford, CA 94304, USA; VA Palo Alto Division of Plastic and Reconstructive Surgery, VA Palo Alto, 3801 Miranda Avenue, Building 100, Room F4-241, Palo Alto, CA 94304, USA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Stanford, CA 94304, USA; Plastic and Hand Surgery Laboratory, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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Zhu J, Yang Y, Li W. Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap. Br J Oral Maxillofac Surg 2014; 52:163-7. [DOI: 10.1016/j.bjoms.2013.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/31/2013] [Indexed: 12/01/2022]
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