Flap For Mandibular Reconstruction Research Articles

Unleashing the potency of multi-segmental DCIA flap in mandibular reconstruction with the aid of virtual surgery- A retrospective cohort study.

Although the deep circumflex iliac artery (DCIA) flap is a mainstay in mandibular reconstruction, its multi-segmental utilization is infrequently reported, primarily due to concerns regarding the variable cutaneous component and potentially inadequate vascular supply to multi-block segments. This retrospective study analyzed the outcomes of 86 patients undergoing mandibular reconstruction with multi-segmental DCIA flaps, compared to 167 patients who received conventional single-segmental flaps. The survival rate for multi-segmental flaps was comparable to that of single-segmental flaps (100% vs. 98.2%, p=0.553). Multi-segmental flaps were used to reconstruct longer bony defects (median: 9cm vs. 6.5cm, p<0.001). Despite the longer operation times in the multi-segmental group (368.8 vs. 326.8min, p<0.001), there was no significant increase in the incidence of surgical complications. Furthermore, postoperative QoL and Harris Hip scores did not show significant differences, despite the increased graft lengths and segmentation in the multi-segmental group. The study underscores the underrecognized efficacy of multi-segmental DCIA flaps in complex mandibular reconstructions, particularly for specific types of defects such as Brown III, Brown I (Ic), and Brown II (IIc), which can be effectively and reliably reconstructed with the aid of virtual surgical techniques. This research also confirms that concerns regarding soft tissue management with multi-segmental DCIA flaps can be effectively addressed.

Fibula free flap for mandibular reconstruction following total en bloc resection in ameloblastoma: a case report and literature review

Background: The fibular free flap is considered the gold standard in mandibular bone reconstruction. It has a high survival rate, is well-vascularized, and fits seamlessly into long-bone defects. The purpose of this article is to describe the use of vascularized fibular free flap in mandibular reconstruction after total en bloc resection in case of ameloblastoma suspected of repeated trauma to the mandible. Case Presentation: A case report of a 26-year-old patient undergoing a mandibular reconstruction using fibula osteocutenous free flap following total en bloc resection due to ameloblastoma on mandibular symphisis region was monitored using Doppler ultrasound every 15 minutes for three to five days. Within four months of treatment, the patient had improved, and the graft was found to be viable. Conclusion: The severity and size of the affected tissue, the tumour's histological arrangement, and the consequences were the influence of whether or not ameloblastoma patients should require surgery. To determine the best course of treatment for each individual case of ameloblastoma, an accurate clinical examination and image evaluation are required.

Fibula free flap for mandibular reconstruction following total en bloc resection in ameloblastoma: a case report and literature review

Background: The fibular free flap is considered the gold standard in mandibular bone reconstruction. It has a high survival rate, is well-vascularized, and fits seamlessly into long-bone defects. The purpose of this article is to describe the use of vascularized fibular free flap in mandibular reconstruction after total en bloc resection in case of ameloblastoma suspected of repeated trauma to the mandible. Method: A case report of a 26-year-old patient undergoing a mandibular reconstruction using fibula osteocutenous free flap following total en bloc resection due to ameloblastoma on mandibular symphisis region was monitored using Doppler ultrasound every 15 minutes for three to five days. Result: Within four months of treatment, the patient had improved, and the graft was found to be viable. Conclusion: The severity and size of the affected tissue, the tumour's histological arrangement, and the consequences were the influence of whether or not ameloblastoma patients should require surgery. To determine the best course of treatment for each individual case of ameloblastoma, an accurate clinical examination and image evaluation are required.

Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction.

Bone resorption of more conventional vascularized bone grafts have been well described showing minimal resorption over time. Few studies have evaluated osseous union and bone resorption in scapula tip free flaps (STFF) in the reconstruction of mandibulectomy defects. We aimed to describe our series on STFF with respect to osseous union and bone resorption over time. Retrospective chart review of patients receiving STFF from January 2014-January 2017 (n=25). A neuroradiologist analyzed follow-up CT scans to assess (1) STFF complete, partial, or no osseous union with native mandible and (2) STFF volume change over time in a subset with multiple follow-up scans (n=18). Twenty-three of 25 patients (92%) showed complete or partial STFF osseous union with native mandible either distally or proximally. STFF volume change ranged from +4.8 to -54% (median -0.5%) over median follow-up interval of 23 months. History of chemoradiation therapy, bisphophonate use, sex, age, or smoking history did not correlate with bone resorption. STFFs shows high rates of osseous union and limited bone resorption that is equivalent to, or less than, vascularized fibular and iliac crest flaps. Clinically, this translates into both optimal healing andfunctional and cosmetic outcomes, especiallyin the setting of prior therapies. 4 Laryngoscope, 133:2597-2602, 2023.

A Brief Clinical Study: The Use of a Custom Guide for Scapula Free Flap Harvest and Mandibular Reconstruction.

Head and neck cancer can leave patients with significant defects requiring major reconstruction. The scapula free flap remains a relatively underused flap choice. This article examines the novel use of a custom guide for a scapula free flap in mandibular reconstruction following resection. A case file was created involving a consultant surgeon, KLS advisor, and technical team based in Belgium. A computed tomography scan of the mandible was sent electronically to render a 3-dimensional model. Custom cutting guides for resection and scapula graft harvest were fabricated. A custom plate for fixation was also developed. The scapula free flap was successfully placed using custom guides. In this case, the use of a custom guide enabled easier harvest, manipulation, and handling of the scapula free flap into the defect. The use of new technology and computer-generated guides represents a considerable shift forward into improving precision in complex surgical procedures and reducing intraoperative time. The use of a custom guide can provide an easier means to handle and manipulate one of the largest free flaps in surgery, the scapula free flap.

Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis.

An evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction. From inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated. Twenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34)). Within the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate.

Three-dimensional Printing Technology for Deep Circumflex Iliac Artery Flap: From Recipient to Donor Sites.

SummaryThe deep circumflex iliac artery (DCIA) flap is one of the most commonly used vascularized free flaps for jaw reconstruction; however, its clinical application is limited by donor site complications. We aimed to describe a new technique of using 3-dimensionally (3D) printed patient-specific devices for mandibular reconstruction with DCIA flap and simultaneous dental implants, and for donor site restoration after harvesting the DCIA flap. One patient with mandible ameloblastoma underwent mandibular reconstruction using a DCIA flap with the “jaw-in-a-day” approach. The 3D-printed patient-specific devices included mandibular cutting guides, DCIA harvesting and dental implant guide, surgical plate, and iliac prosthesis. The postoperative 1-month accuracy measurement showed the mean distance deviations of the mandible, transferred bone grafts, dental implants and iliac prosthesis were 1.8 mm, 2.1 mm, 0.9 mm, and 1.2 mm, respectively. Three-dimensionally printed iliac prosthesis satisfactorily restored the contour of the iliac crest after DCIA flap harvesting. No complication of donor site was recorded during the follow-up of 12 months. We successfully used 3D-printed patient-specific implants in both donor and recipient sites for DCIA flap jaw reconstruction. Further studies with a larger sample size and long-term follow-up are needed.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.

Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

Preparation of a Surgical Guide for the Prevention of Injury to the Angular and Periosteal Branches While Performing Osteotomy for the Harvest of Vascularized Scapular Chimeric Free Flap for Mandibular Reconstruction

Preparation of a Surgical Guide for the Prevention of Injury to the Angular and Periosteal Branches While Performing Osteotomy for the Harvest of Vascularized Scapular Chimeric Free Flap for Mandibular Reconstruction

Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction

Titanium plate fixation of free flaps in mandibular reconstruction involves complications such as osseous non-union or imaging artefacts. Interosteotomy movement (IOM) is known to affect bone healing. This study aimed to compare IOM and mechanical integrity of four different fixation systems in a mandible reconstruction model. Two polyurethane (PU) fibula segments were fixed in right-sided defects of PU mandibles. Laser-melted patient-specific titanium plates were fixed with non-locking-screws (Ti-NL) or locking-screws (Ti-L). The third group consisted of locking-screws for patient-specific polyetheretherketone (PEEK-L) plates. The last group used titanium miniplates and monocortical screw fixation (Ti-MP). All models were loaded unilaterally via cyclic dynamic loading with increasing loads to simulate mastication. IOM was registered using a 3D optical tracking system. PEEK-L showed highest vertical displacement (p=0.010), lowest stiffness (p=0.004) and highest IOM (p=0.001). All specimen in PEEK-L demonstrated abnormal bending (n=5) or plate fracture (n=1). Vertical displacement or stiffness did not differ between any of Ti-MP, Ti-L and Ti-NL. IOM in Ti-MP was higher than in Ti-L and Ti-NL (p=0.001). Mechanical integrity of all titanium plates complies with established standards. In this model, the screw system did not influence IOM. In the tested composition and shape, PEEK plates do not seem to guarantee sufficient mechanical integrity for a use in mandibular reconstruction. Thus modifications are needed. Future clinical studies are needed to clarify optimal IOM after mandible reconstruction.

Determining the optimal osteotomy distance with the fibula free flap in mandibular reconstruction.

Fibula free tissue transfer is a common and reliable method for mandibular reconstruction. Functional outcomes from this procedure are dependent on the successful union of the osseous segments postoperatively. This study was conducted to define the maximum gap-size criteria for osseous union to occur at osteotomy sites in fibula free flap reconstruction of the mandible. Retrospective chart review. Tertiary care academic center. A retrospective chart review of computed tomography and medical records was conducted on patients who underwent fibula free flap surgery and had imaging of the mandible at <3months and >6months after surgery. Distances between osteotomies were measured and evaluated for interval healing. Secondary data included subject age, sex, smoking status, diabetes, number of osteotomies, complications, and adjuvant therapy. Thirty-eight osteotomy sites were analyzed from thirteen subjects and a total of 190 measurements were made. The mean gap size at the first scan that demonstrated union by the second scan interval was 1.31mm and mean gap size demonstrating non-union was 2.55mm (p<0.01). Complication rate, number of osetotomies, adjuvant therapy, or medical co-morbidities did not significantly affect rates of union. In this study, osseous union was achieved with a mean osteotomy gap size of 1.31mm. The data suggests that distances between ossesous segments >2.55mm have a higher risk of non-union. We believe the information from this study will help augment current and future techniques in the field of mandible reconstruction.

Role of Axial Split Osteotomy of Free Fibula Flap in Mandibular Reconstruction and Dental Rehabilitation.

Summary:The fibula free flap (FFF) is regarded as the gold standard in mandibular reconstruction. Dental rehabilitation is important to improve the health-related quality of life of patients undergoing mandibular reconstruction. FFF provides adequate cortical bone osseous tissue for use in dental implantation. The application of “axial split osteotomy” via a double-barrel fibula graft may enable discrepancies between the native mandible and FFF to be avoided, thereby improving the likelihood of early and successful dental rehabilitation.

Free Fibula Flaps for Mandibular Reconstruction in Children with Congenital Anomalies: A Systematic Review

Free Fibula Flaps for Mandibular Reconstruction in Children with Congenital Anomalies: A Systematic Review

Outcomes analysis of non-vascularized bone graft and free flap in mandibular reconstruction

Outcomes analysis of non-vascularized bone graft and free flap in mandibular reconstruction

3D virtual planning for vascularized fibula flap for mandibular reconstruction after ressection of ameloblastoma

3D virtual planning for vascularized fibula flap for mandibular reconstruction after ressection of ameloblastoma

Bone surface increase through fenestration of the micro-vascularized fibula flap for mandibular reconstruction

Bone surface increase through fenestration of the micro-vascularized fibula flap for mandibular reconstruction

Early experience with vascularised fibula free flap in mandibular reconstruction

All free vascularised fibula grafts performed at our unit were assessed retrospectively with respect to success and complications. Between 2007 and 2014 there were 11 males and 9 females with a follow-up from 2 to 6 years. The mean bony defect length was 14 cm. Bony union was assessed radiographically and was seen in 18 cases. One flap failed and another was salvaged despite anastomotic failure. There was one post- operative death. Otherwise serious complications and donor site morbidity were acceptable. Vascularised fibula reconstructions should be considered a valuable treatment option for patients with hemimandibular or segmental mandibular defect reconstructions of more than 9.5 cm. Paying greater attention to detail will help minimize and prevent postoperative complications.

How to harvest free fibula flap for mandibular reconstruction? Practical tips and tricks

How to harvest free fibula flap for mandibular reconstruction? Practical tips and tricks

The Osteomyocutaneous Free Fibula Flap in Mandibular Reconstruction

The Osteomyocutaneous Free Fibula Flap in Mandibular Reconstruction

Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading

Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3). Groups 1 (p = 0.045) and 2 (p = 0.034) showed significantly shorter delays when compared with Group 3. Significant differences in average counts of implants placed were also found between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019). The ratio of planned to placed implants was highest in Group 1. The observed differences between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019) were significant. Our results indicate an accelerating effect of CAD/CAM on graft consolidation and dental rehabilitation.