Delayed reconstructive plastic surgery in patients with tumors of the maxillofacial region: literature review

Abstract

Introduction. The main treatment option for malignant neoplasms of the head and neck is combined. However, survival rates are still relatively unchanged. The surgical stage of treatment leads to extensive defects that are eliminated through reconstructive technologies. Despite the priority of performing reconstruction at the same time, delayed reconstructions are still being discussed 6–12 months after surgical treatment; therefore, it is necessary to develop new methodological and practical approaches.Aim. To determine the features of the delayed reconstructive-plastic stage in patients with malignant tumors maxillofacial region, evaluation of possible solutions for optimizing the stage.Material and methods. The analysis of available literature sources was taken in the database Medline, Pubmed, eLibrary, etc. The 101 studies were found, 60 were used to write a systematic review.Results. Delayed reconstructive plastic surgery should take into the possibility more complex and larger defects of soft and bone tissues during the reconstructive stage, previous surgery and/or radiation therapy create significant difficulties for the identification of recipient vessels. Computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies allow projecting the design and positioning of reconstructive material at the preoperative stage. Mandibular reconstruction is the most difficult, that isn’t achieve only an aesthetic result, but also to restore the biomechanics of the temporomandibular joint. The development of specific complications hinders the improvement of the patient’s quality of life. In the early postoperative period is may develop necrosis of the flap, thrombosis of vascular pedicle, hematoma; in the late postoperative period plate extrusion is still one of the common complications, planning delayed reconstruction an important aspect is prevention or treatment of osteoradionecrosis. The combination of precarbohydrate loading and dalargin will allow to reduce the frequency of perioperative complications and improve the long-term results of surgical treatment.Conclusion. Reconstructive treatment in patients with defects requiring postponed reconstructive surgeries is a complex problem which requires development of an integrated approach with detailed analysis of the existing defect and previous antitumor therapy.