Abstract
Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap.
Highlights
Facial contours and tissues have been corrected using a variety of surgical reconstructive procedures, including autogenous bone and cartilage grafts, fat, muscle, alloplastic materials, and microvascular free flaps [1,2,3,4]
We studied the vascular supply to the pericranial temporoparietal region in order to determine whether a galeo-pericranial flap with superficial temporalis vascularisation could be harvested
The patients had undergone ablative surgery to treat oral squamous cell carcinoma (OSCC) and were candidates for maxillary/upper alveolar gingiva reconstruction using a composite galea-pericranium pedicled flap, as described below. Since this is designed as a viability study without previous clinical robust data demonstrating the efficacy of bone regeneration from a galeo-pericranial flap, we decided to apply this reconstruction to anatomical defects where bone free flaps were considered as an overtreatment
Summary
Facial contours and tissues have been corrected using a variety of surgical reconstructive procedures, including autogenous bone and cartilage grafts, fat, muscle, alloplastic materials, and microvascular free flaps [1,2,3,4]. The gold standard for both soft tissue and bony reconstruction of large head and neck surgical defects is the microvascular free flap [2,3]. The radial region and femoral medial condyle are the most common donor sites for free periosteal grafts for head and neck reconstruction [5,6]. The temporal region is an important donor site during head and neck reconstructive surgery, from which pedicled flaps, including muscle, fascia, and skin flaps, can be harvested. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. This enhances the surgeon’s view of the physical environment without any need for invasive preoperative placement of fixed fiducial markers. Augmented reality was used to guide the anatomical flap design
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