Method Of Choice For Reconstruction Research Articles

Spinal Giant Cell Tumor in Neurospine Surgery: A Narrative Study

Background and Aim: Spinal Giant Cell Tumor (GCT) is a primary low-grade malignant aggressive tumor of the spine and is more prevalent in the third and fourth decades of life. Spinal GCT frequently occurs in the sacrum. The most common presentation of spinal GCT is pain. Spinal GCT is seldom observed as an asymptomatic, incidental radiological occurrence. Based on the clinic-radiological findings, differential diagnoses of spinal GCT are Aneurismal Bone Cyst (ABC), plasmacytoma, symptomatic hemangioma, and Tuberculosis (TB). A biopsy is crucial for a definitive diagnosis. Because of the rich vascular supply about 24 hours prior to operation, Digital Subtraction Angiography (DSA) with tumor embolization is recommended. The treatment of choice for these tumors is complete, extralesional surgical resection which is not usually possible. General treatment is resorted as incomplete partial resection following local radiotherapy. The method of choice for reconstruction is cement or metallic cages and because of the high recurrence rate, bone graft is avoided. The local recurrence rate in the spinal column is lower than in other areas. Methods and Materials/Patients: The spinal GCT incidence, manifestations, diagnosis, and management were concisely reviewed. Using the keywords of GCT, GCT manifestations, GCT complications, GCT management, and GCT incidence, all the relevant articles were retrieved from Google Scholar, Medline, and PubMed, reviewed critically, and analyzed. Results: Spinal GCT rarely presents as an incidental finding in radiologic studies. Because of the high vascular supply of GCTs, preoperative embolization must be performed. The ideal treatment of spinal GCT is complete surgical tumor excision and when not possible, intralesional resection is an alternative treatment. The prognosis of spinal GCT is not good as other primary spinal tumors because of incomplete excision of the tumor and following high recurrence rate. Conclusion: Spinal GCTs are complex clinical entities. Operation is obligatory, and postoperative close follow-up is mandatory to stop recurrences early

PERFORMANCE STATUS AND QUALITY OF LIFE AFTER RECONSTRUCTIONS OF BUCCAL MUCOSAL AND RETROMOLAR TRIGONE DEFECTS BY SKIN AND FASCIAL FLAPS IN ONCOLOGYCAL PATIENTS

The aim: of the study is to compare surgical and functional results as well as quality of life after use of skin flaps - platysma myocutaneus flap, supraclavicular artery flap and fascial flaps - temporoparietal fascial flap, buccal fat pad for plastic closure of the buccal and retromolar trigone mucous surgical defects in cancer patients. Material and methods: A retrospective comparative analysis of the results of surgical treatment of buccal and retromolar trigone mucosal cancer in 56 patients operated from 2009 to 2014 was made. The patients were divided into two groups: the first included 26 patients, with reconstruction of fascial flaps, the second group included 30 patients, with reconstruction of postoperative defects with skin flaps. Surgical results: the average duration of surgery, the average duration of inpatient treatment and the presence of complications were compared in the both groups. Functional results in both groups were compared in 6 and 12 months after surgery with the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN), and quality of life was assessed by the University of Washington Quality of Life questionnaire, version 4. Results: Average duration of surgery, average time of inpatient treatment, and postoperative complications did not differ significantly in both groups (P> 0.05). Data of performance status and quality of life in patients with reconstruction of mucosal defects and retromolar trigone with skin flaps were significantly better (P> 0.05) in 6 and 12 months after surgery, compared with the group of patients who underwent defect reconstruction with fascial flaps. Conclusions: The method of choice in reconstruction of medium and large defects of the buccal and the retromolar trigone mucous is usage of skin flaps: the platysma myocutaneus flap and the flap of the supraclavicular artery.

Peritoneal flap hernioplasty for reconstruction of transverse incisional hernias.

Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this problem using flaps of hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. The operative technique and long-term results of 80 consecutive cases with transverse incisional hernias undergoing repair with this method are reported. Patients undergoing elective peritoneal flap hernioplasty repair for transverse incisional hernias from Jan. 1, 2010 to Dec. 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in May 2019 from hospital records and telephone interview. 80 patients, (n = 53 male, 66%) were identified. Mean follow-up was 83months (range 55-114months) and mean postoperative stay was 6.4days (range 1-23days). Eleven repairs (14%) were for recurrent hernia. Mean mesh size applied (Optilene Elastic, 48g/m2, BBraun) was 747cm2 (ranged 150-1500cm2). Redundant skin excision was performed in 54% of cases. Altogether, seven patients (8.8%) presented with postoperative complications: five superficial wound infections (6.3%), one symptomatic seroma (1.3%) and one recurrence (1.3%) within the follow-up period. The peritoneal flap hernioplasty is associated with few complications and a very low recurrence rate. We propose this technique as the method of choice for reconstruction of transverse abdominal incisional hernias when primary fascial apposition is not possible.

THE USE OF SUBMENTAL LOCAL FLAP AND RADIAL FREE FLAP FOR THE RECONSTRUCTION OF DEFECTS IN PATIENTS WITH ORAL CANCER

Introduction.Due to anatomical features, surgical treatment of oral cancer can lead to significant functional and esthetic defects. Main methods of reconstruction can be divided into groups of local and free flaps. There are lots of publications devoted to reconstruction of defects of oral cavity with the use of local and free flaps, but only few of them contain the comparison of these methods in the aspect of functional results.Materials and methods.A total of 58 patients with oral cancer were included in our study. All patients received surgical treatment with one-time reconstruction of defect. In 34 cases we used free radial flap and in 24 – submental local flap.Results.The use of submental flap has advantages in the intraoperative time, time of recovery, functional results, with the same locoregional control.Conclusions.We suggest submental local flap and radial free flap to be the method of choice in reconstruction of mucosa and soft tissues defects in patients with primary and recurrent oral cancer.

Layered sellar reconstruction with avascular free grafts: Acceptable alternative to the nasoseptal flap for repair of low-volume intraoperative cerebrospinal fluid leak.

Although the nasoseptal flap has become the method of choice for reconstruction of intraoperative cerebrospinal fluid (CSF) leak in endoscopic minimally invasive surgery of the skull base, layered avascular graft techniques, including allografts and middle turbinate mucosal autografts, may provide comparable reconstructive success with decreased nasal morbidity. To describe a method of reconstruction of intraoperative CSF leak in endoscopic surgery of the sella turcica and analyze its postoperative success rate and associated comorbidities. A retrospective review of expanded endonasal sellar tumor resections from 2008-2014 was performed, and cases of layered intraoperative skull base reconstruction with avascular free grafts were identified. Demographic factors and comorbidities that predisposed to reconstruction failure (obstructive sleep apnea, obesity) were determined. Reconstruction-related nasal complications were also identified. Postoperative CSF leak rate was determined, and statistical analysis was performed to identify predictive factors for reconstructive failure. Seventy-three cases were identified. Layered closure with avascular free grafts was performed. There were five cases of postoperative CSF leak (6.85%). The mean follow-up was 19 months (range, 1-76 months). Intraoperative high-flow CSF leak was a significant predictor of reconstruction failure on univariate (odds ratio 22 [95% confidence interval, 2.26-214]; p = 0.008) and multivariate analysis (odds ratio 33.6 [95% confidence interval, 2.30-492]; p = 0.010). There were no significant differences in postoperative leak rates among bony overlay graft types. There were five patients (7.9%) who experienced persistent crusting after surgery. There were no significant differences in crusting rates between allografts and mucosal grafts. There were no postoperative mucoceles. In cases of low-volume intraoperative CSF leak, layered skull base repair with avascular free grafts was an acceptable alternative to the nasoseptal flap, which may reduce prolonged sinonasal healing and donor-site morbidities.

Reconstruction of Large Acquired Scalp Defects: Ten-Year Experience.

The method of choice for reconstruction of large acquired scalp defects depends on numerous factors. The aim of our study was to analyze reconstructions of large acquired scalp defects performed on 135 patients in the period of 10 years. We have monitored the factors with an impact on the reconstruction method, complications, and the achieved results. Skin grafts, local, regional and free flaps, have been applied for reconstruction of defects. The depth, size, defect localization, condition of surrounding tissue, co-morbidities and causes of occurrence of defect have an impact on the method of choice for defect reconstruction. Acquired scalp defects are the most frequent in the older population and, in most cases, occur upon the surgical removal of malignant tumors. Local fasciocutaneous flaps are the method of choice for small and acquired scalp defects of medium size while free flaps are the best solution for reconstruction of the large full-thickness scalp defects. Frequency of severe complications is significantly higher in the patients who undergo craniotomy, or those with liquorrhea.

A study of autologous free fat transplantation for augmentation of contour deformities of face: a study of 10 cases with review of literature

Increased understanding, improving technology and the latest advances along with growing emphasis on the operative details over a period of last 100 years are the important factors due to which, 'free fat transplant' is now becoming a method of choice for reconstruction of soft tissue deformity of face. Although it requires initial overfilling of the fat and also considering the possibility of uncontrolled, unpredicted absorption of the injected fat, transplant of the free fat itself being a simple and cost effective procedure has emerged out to be a treatment of choice for contour deformities of face and is preferred over other methods of soft tissue reconstruction for the face. It gives natural look and feel to the tissue and also has less post-operative consequences comparatively. Here we present our experience of free fat auto-transplant for soft tissue reconstruction of face by taking into account ten cases in whom, we performed the procedure and kept a follow-up to obtain the exact status of results, benefits and complications. Also we are comparing our result with that mentioned in the literature and presenting it with a review.

Bilateral V-Y advancement gluteal fold flaps following vulvo-vaginal melanoma resection

The soft tissue defects of the anterior perineum can be caused by tumour excision, trauma, burns, Fournier’s gangrene and genital mutilation. Various reconstruction methods were described: vacuum-assisted closure, skin grafts and skin substitutes, pedicled or free flaps. In the case of defects following oncologic surgery, flaps are the reconstructive method of choice. We present the case of a 65 year-old woman diagnosed with stage III A vulvo-vaginal melanoma affecting also the distal urethra. Radical vulvectomy and en-bloc excision of the anterior third of the vagina and distal urethra, along with bilateral inguinal lymphadenectomy was performed. The resulting defect was covered with bilateral V-Y advancement gluteal fold flaps. A local vaginal recurrence appeared 18 months after surgery and was safely removed. The patient followed chemotherapy with Dacarbazine. The gluteal fold flap offered good defect coverage and survived completely. Follow-up period was two years without distant metastases. Functional result was excellent, urinary function being normal and patient satisfaction high. Due to the gluteal flap’s advantages (appropriate thickness, good vascularity, minimal donor site morbidity, and same operative field allowing for shorter operating time), reconstruction of the anterior perineum after oncological resection with bilateral V-Y advancement gluteal flaps is a viable solution.

Surface-optimized free flaps for complex facial defects after skin cancer

Advanced non-melanocytic skin cancer (NMSC) in the facial region causes extensive tissue loss, possibly coverable by local flaps. Remote free flaps are the reconstructive method of choice, despite disadvantages such as color and texture mismatch, and bulkiness with regard to facial skin. Post-ablative facial NMSC defects in four patients were reconstructed using remote free flaps, including radial forearm, scapular, parascapular, and anterolateral thigh flaps. Four months later, a split-thickness skin graft (STSG) was acquired from the retroauricular region to generate a non-cultured autologous epidermal cell (NCAEC) suspension. The flap surfaces were de-epithelialized, and the NCAEC suspension was sprayed onto the flap surface to improve the mismatch between facial and flap color. Debulking was also carried out. The aesthetic outcome was examined by photography and clinical examination 3, 6, 9, and 12 months after the first operation. All flaps survived the 11- to 21-month follow-up. The secondary operation was accompanied by a delay in re-epithelialization in one case. No STSG donor-site problems occurred. Follow-up photographs showed significant improvements in the color and texture of the flaps. Facial reconstruction with a free flap results in a mismatch of color and texture. Secondary correction of the flap surface by de-epithelialization and NCAEC application significantly improves the aesthetic outcome.

Free tissue transfer for head and neck reconstruction: a contemporary review.

Microvascular free tissue transfer is used for complex composite tissue defects in previously treated fields, in particular after treatment of malignant disease. The increasing incidence of skin cancer in the general population has increased the number of patients with massive tumors that require the expertise of the free flap reconstructive surgeon. We herein examine a number of the recent advances in the field that use free tissue transfer for orbitomaxillary and scalp reconstruction, including maxillary reconstruction, virtual surgical planning in head and neck reconstruction, and scalp reconstruction. Advanced computer algorithms allow planning of these procedures at a savings of time and cost. Free tissue transfer is a reconstructive modality that is often at the top of the reconstructive ladder and, in some instances, is the reconstructive method of choice. The ability to harvest composite tissue that matches the tissue defect in composition, surface area, and volume makes free tissue transfer a versatile modality.

Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases.

BackgroundThe aim of this study is to define an algorithm for the choice of reconstructive method for defects after laryngo-pharyngo-esophagectomy for hypopharyngeal carcinoma.MethodsOne hundred and forty two cases of hypopharyngeal carcinoma were included and operated on by either partial pharyngectomy, total pharyngectomy or esophagectomy. The reconstructive method was tailored according to the resected segment.ResultsPectoralis flap was used in 48 cases, free jejunal flap in 28 cases, augmented colon bypass in 4 cases, gastric pull up in 32 cases and gastric tube in 30 cases. Mean hospital stay was 12 days. Mortality rate was 10.6% and morbidity rate was 31.7%. Total flap failure occurred in 3 cases of free flap and one case of pectoralis flap. There were 23 cases of early fistula. Late stricture occurred in 19 cases, being highest with myocutaneous flap (early fistula 12/50 and late stricture 13/50).ConclusionFree jejunal flap was the flap of choice for reconstruction when the safety margin is still above the clavicle. In cases with added esophagectomy, we recommend gastric tube as a method of choice for reconstruction.

Functional outcome of limb salvage surgery with mega-endoprosthetic reconstruction for bone tumors

The use of a mega-endoprosthesis has become the method of choice for reconstruction after bone tumors. In this study, we sought to determine the functional outcome and complications associated with mega-endoprosthesis. A retrospective review of the charts of 16 patients who had undergone resection of bone tumors followed by reconstruction with mega-endoprosthesis between 2006 and 2011 was performed. Functional evaluation was based on the Musculoskeletal Tumor Society (MSTS) scoring system. Complications of the procedures were also analyzed. Eight men and eight women at an average age of 36.7 years were included in the study. The tumor involved lower limb in 14 patients and upper limb in 2 patients. The average MSTS functional score was 72.3 ± 15. Excellent results were achieved in six patients, good in five, moderate and fair in two each and poor in one. Complications occurred in eight patients. Two patients had aseptic loosening of the femoral component of total knee replacement. Flap necrosis occurred in two patients, both of whom required latissimus dorsi free flap for coverage of total knee prosthesis. One patient underwent revision of femoral component subsequent to knee dissociation. Local recurrence of tumor, patellar tendon rupture and foot drop occurred in one patient each. Mega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumors.

Incisional hernia of the urinary bladder following internal hemipelvectomy

INTRODUCTIONHemipelvectomies are uncommon operations, usually performed for primary or metastatic malignant disease and less frequently for benign-aggressive tumours. There are very few reports in literature regarding complications of these procedures and even fewer reports about post hemipelvectomy hernias in particular. PRESENTATION OF CASEWe present the only reported case of an incisional hernia of the urinary bladder following internal hemipelvectomy for aneurysmal bone cyst of the pubic bone. A careful literature review is also performed. DISCUSSIONThe development of the incisional hernia in the case of our patient can most likely be explained by the absence of advanced malignant disease of the pelvis that not only reduces the life expectancy but also overshadows other complications post hemipelvectomy. Furthermore, her young age and level of fitness allowed for a full postoperative rehabilitation which, combined with the proven anatomical changes of the internal organs following hemipelvectomies and the weakening of the tissues around the operative site, predisposed to the hernia formation. CONCLUSIONHemipelvectomies are extensive, anatomically disruptive operations, with significant detriment to the psychosomatic well being of the patients. We presented the only reported case of incisional hernia of the urinary bladder following internal hemipelvectomy and our reconstructive method of choice. We believe that, in the case of our patient, if a mesh had been used to reconstruct the primary defect during the initial surgery, this complication could have been prevented.

The Pedicled Transverse Rectus Abdominis Myocutaneous Flap: Indications, Techniques, and Outcomes

Breast reconstruction has evolved significantly during its short, 40-year history. What began as limited reconstruction through the use of local skin flaps has now become an entire array of procedures including novel autologous flaps and new techniques in implant/expander use. Throughout this evolution, the primary goal of reconstruction has always remained the same: to recreate the most natural breast mound possible. In the early 1980s, autologous tissue was at the forefront of breast reconstruction, and the pedicled transverse rectus abdominis myocutaneous (TRAM) flap quickly became the reconstructive method of choice for tissuebased reconstruction. Despite the advent of microsurgery, advances in perforator-based flap design, and increasing procedural complexity, the pedicled TRAM flap is still one of the most common methods of autologous reconstruction performed today. In properly selected patients, the pedicled TRAM flap can provide a natural appearing breast mound with limited morbidity and superior patient satisfaction.

Current Options in Head and Neck Reconstruction

After studying this article, the participant should be able to: 1. Understand current trends in the treatment of head and neck cancer. 2. Discuss the challenges of reconstructing head and neck defects 3. Understand the different reconstructive options available for specific anatomical regions of the head and neck. Reconstructive surgery of the head and neck is both technically challenging and rewarding. In the past 20 years, significant advances in this field have improved surgical outcomes and patient function. The development and subsequent refinement of microvascular techniques, in particular, have been a major reason for this progression. In this article, the authors review the current options available in head and neck reconstruction. Because a large number of major craniocervicofacial defects result from oncologic resection, the authors have focused their review on this particular subject. By dividing their discussion into different anatomical sites, the authors hope to cover all major aspects of this broad topic. Free tissue transfer has revolutionized head and neck reconstruction. The most widely used free flaps include the fibula, radial forearm, anterolateral thigh, and rectus abdominis. Restoration of both form and function is the ultimate goal. Although defects of the head and neck region present a challenge, successful cosmetic and functional results have been achieved with both local and free tissue flaps. The flexibility of free tissue transfer, however, has dominated this area and continues to be the method of choice for reconstruction of sizable defects.

Surgical treatment and clinical course of patients with hypopharyngeal carcinoma

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.

Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction

Utilization of vascularized bone grafts rigidly fixated with titanium reconstruction plates is the method of choice for reconstruction of segmental mandibular defects. We hypothesized that the use of the newer 2.0-mm locking reconstruction plate (LRP) is not associated with higher rates of complications when compared with larger, previously used plating systems. A retrospective case series of 184 patients undergoing 185 vascularized bone graft reconstruction procedures of the mandible was conducted. There were 37 plate complications. There was no significant difference in complication rates for the 2 most used plate types (14.5% with the 2.0-mm LRP and 22.2% with the 2.4-mm LRP). Use of the smaller 2.0-mm LRP was not associated with an increase in the complications of plate fracture, exposure, infection, or nonunion. Because of its lower profile and ease of application, the 2.0-mm LRP is our plate of choice for mandibular reconstruction.

SURVIVAL OF TOTAL KNEE REPLACEMENT WITH A MEGAPROSTHESIS AFTER BONE TUMOR RESECTION

Background: The use of a megaprosthesis has become the method of choice for reconstruction after bone tumor resection at the knee. However, the long-term survival of megaprostheses is poor. In this study, we sought to identify factors that were associated with implant failure and amenable to interventions designed to improve implant survival. Methods: A retrospective review of the charts of ninety-one patients who had undergone resection of a tumor of the knee followed by reconstruction with a custom-made megaprosthesis was performed. The distal part of the femur was resected in fifty-six patients and the proximal part of the tibia, in thirty-five patients. The reconstruction was performed with an allograft-prosthesis composite in thirty-three patients and with metal or plastic sleeves in fifty-eight patients. Reconstruction of the extensor mechanism was necessary in all thirty-five patients with a tibial tumor. Results: The median duration of follow-up was sixty-two months. The extensor mechanism was significantly less likely to rupture when partial continuity had been preserved at the time of the resection. Intra-axial laxity (an arc of motion of >5° in the frontal plane) was significantly more common when the prosthesis had an antirotation pin than when it did not have an antirotation pin (p = 0.0023). There was mechanical failure of ten allograft-prosthesis composites and ten sleeve reconstructions. Thirty-six patients had removal of at least one component of the prosthesis. When revision due to local tumor recurrence was excluded, the median duration of prosthetic survival was 130 months following the distal femoral resections and 117 months following the proximal tibial resections. The median duration of survival was 117 months for the allograft-prosthesis composites and 138 months for the sleeve reconstructions. Body weight and activity level were independent predictors of early revision. Conclusions: The long-term survival of the knee megaprostheses in this study was poor. Mechanical failure was multifactorial and the leading cause of revision. Use of allograft-prosthesis composites and use of bushings or an antirotation pin appeared to have no mechanical benefits. We recommend that weight control programs and advice about adapting their activity level be offered to patients preoperatively. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Survival of Total Knee Replacement with a Megaprosthesis After Bone Tumor Resection

The use of a megaprosthesis has become the method of choice for reconstruction after bone tumor resection at the knee. However, the long-term survival of megaprostheses is poor. In this study, we sought to identify factors that were associated with implant failure and amenable to interventions designed to improve implant survival. A retrospective review of the charts of ninety-one patients who had undergone resection of a tumor of the knee followed by reconstruction with a custom-made megaprosthesis was performed. The distal part of the femur was resected in fifty-six patients and the proximal part of the tibia, in thirty-five patients. The reconstruction was performed with an allograft-prosthesis composite in thirty-three patients and with metal or plastic sleeves in fifty-eight patients. Reconstruction of the extensor mechanism was necessary in all thirty-five patients with a tibial tumor. The median duration of follow-up was sixty-two months. The extensor mechanism was significantly less likely to rupture when partial continuity had been preserved at the time of the resection. Intra-axial laxity (an arc of motion of >5 degrees in the frontal plane) was significantly more common when the prosthesis had an antirotation pin than when it did not have an antirotation pin (p = 0.0023). There was mechanical failure of ten allograft-prosthesis composites and ten sleeve reconstructions. Thirty-six patients had removal of at least one component of the prosthesis. When revision due to local tumor recurrence was excluded, the median duration of prosthetic survival was 130 months following the distal femoral resections and 117 months following the proximal tibial resections. The median duration of survival was 117 months for the allograft-prosthesis composites and 138 months for the sleeve reconstructions. Body weight and activity level were independent predictors of early revision. The long-term survival of the knee megaprostheses in this study was poor. Mechanical failure was multifactorial and the leading cause of revision. Use of allograft-prosthesis composites and use of bushings or an antirotation pin appeared to have no mechanical benefits. We recommend that weight control programs and advice about adapting their activity level be offered to patients preoperatively.

Simple Reconstruction with Titanium Mesh and Radial Forearm Flap after Globe-Sparing Total Maxillectomy: A 5-Year Follow-Up Study

Reconstruction of eye globe-sparing total maxillectomy defects is one of the major challenges to reconstructive surgeons. In 1994, the authors developed an uncomplicated and easy reconstructive method, where a titanium mesh is applied for the support of orbital contents, a radial forearm free flap for covering the mesh and the cheek lining, and an obturator prosthesis for palatal and dental rehabilitation. Five patients who underwent primary reconstruction with the authors' method after globe-sparing maxillectomy with loss of the orbital floor from 1994 to 1999 and who were followed up for more than 5 years were retrospectively reviewed for (1) the presence of diplopia, (2) the shape of the reconstructed orbital floor assessed by coronal section magnetic resonance imaging, and (3) the presence of infection/exposure of the titanium mesh. Only one of the five patients developed slight diplopia. Coronal magnetic resonance imaging showed that the orbital floor restored with titanium mesh had in all cases maintained a proper shape and position for more than 5 years. No infection or exposure of the titanium mesh had developed in any of the cases, despite exposure to irradiation of not less than 30 Gy. All the patients had well-retentive obturator prostheses. This long-term follow-up study demonstrated that the authors' method attained a long-lasting successful outcome functionally and is the method of choice for reconstruction after globe-sparing total maxillectomy.