Mandibular reconstruction with composite microvascular tissue transfer
- Emory Univ. School of Medicine, Atlanta, GA (USA)
Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons (lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)). Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure.
- OSTI ID:
- 6320436
- Journal Information:
- American Journal of Surgery; (USA), Vol. 160:4; ISSN 0002-9610
- Country of Publication:
- United States
- Language:
- English
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FACE
SURGERY
WOUNDS
HEALING
CARCINOMAS
ORAL CAVITY
OSTEORADIONECROSIS
PATIENTS
RADIOTHERAPY
SKELETON
SKIN
TONGUE
BIOLOGICAL EFFECTS
BIOLOGICAL RADIATION EFFECTS
BIOLOGICAL RECOVERY
BODY
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DIGESTIVE SYSTEM
DISEASES
HEAD
INJURIES
LOCAL RADIATION EFFECTS
MEDICINE
NECROSIS
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PATHOLOGICAL CHANGES
RADIATION EFFECTS
RADIATION INJURIES
RADIOLOGY
RECOVERY
SKELETAL DISEASES
THERAPY
560151* - Radiation Effects on Animals- Man
550600 - Medicine