Rib Graft Research Articles

Surgical Treatment of Thoracolumbar Pott’s Disease at Niamey National Hospital (HNN) about 34 Cases

Pott's disease or tuberculous spondylodiscitis is one of the most serious forms of osteoarticular tuberculosis, responsible for spinal cord compression and/or "cauda equina" syndrome due to granulomatous and/or abscessed tuberculous epiduritis. Surgery therefore plays a key role in the management of this pathology, although surgical techniques vary widely from one author to another and from one department to another.
 The aim of our work is to describe the different techniques used in our department during the study period, and to evaluate the results.
 This is a prospective study concerning 34 cases of dorsolumbar and lumbar Pott's disease collised in the neurosurgery department of Niamey National Hospital from January 2020 to December 2021.
 Analysis of our results found 26 men and 8 women with a sex ratio of 3.25; the extreme ages were 11 and 76 years and the mean age was 40.53 years. 20 patients presented with dorsal cord compression syndrome, 12 with cauda equina syndrome, 6 with conus medullaris syndrome and 2 with multifocal localization.
 CT was performed in all patients and MRI in only one. All patients were treated with antibacillary chemotherapy. In 16 patients (47.06%), a posterolateral approach consisting of hemilaminectomy, pediculotomy and unilateral arthrectomy was used; in 9 patients (26.47%) a posterior approach consisting of fenestration; and laminectomy in 4 patients (11.76%). An anterior approach in 3 patients (8.82%), consisting of a corpectomy and an antero-lateral approach (pediculo-artrectomy-corpectomy) in 2 patients (5.89%). All our patients underwent debridement, evacuation of residual pus and sequestrectomy. Out of the debridement filling of the defect was performed in 23 cases with a spinous graft, 2 with fibula, 2 with a rib graft and one with an iliac bone graft.
 At 4 months post-surgery, radicular signs had completely disappeared in all patients, and sensory-motor deficit had improved in 30 patients (88.23%). There was a reduction in kyphosis in all patients who had benefited from an anterior approach, compared with 41.38 % who had undergone a posterior approach.

Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP-P Database.

Microtia and anotia repair require techniques that consider both aesthetics and function. The outcomes of different reconstructive frameworks such as costal cartilage or a porous polyethylene implant have not been evaluated on a national scale. We aim to understand differences in outcomes/complication rates and operative times between different reconstructive frameworks used in microtia/anotia reconstruction. This was a retrospective review of the National Surgical Quality Improvement Program Pediatric database between 2012-2019. Patients with ICD-9/10 codes for microtia/anotia were isolated. Reconstruction methods were identified using CPT codes for rib graft, ear cartilage graft, and alloplastic implants (biocompatible implants, porous polyethylene, etc). Outcomes included operative-time, wound complications, and unplanned re-operations within 30 days of surgery. Multivariable logistic regression was performed to control for confounders. We included 593 patients for analysis. Reconstruction with rib grafts (N = 506, 85%) was the most common. In 58 patients (9.8%), an implant was used for the auricular framework, whereas in 47 (7.9%) ear cartilage grafts were used. The overall wound complication rate was 3.4%. On univariate analysis, alloplastic implants exhibited a higher rate of wound complications (8.6% vs. 2.8%, p = 0.037) and longer operative times (350 min vs. 235 min, p < 0.001). After controlling for demographics and comorbidities, implants conferred an independently increased risk of wound complications (OR 3.52, 1.10-9.54, p = 0.020). Although the use of alloplastic implants (e.g., porous polyethylene) may confer an increased risk of early complications, the long-term clinical implications of these findings are unclear relative to aesthetic benefits. Multi-institutional studies are needed to validate these findings using patient-specific and surgeon-specific data. 3 Laryngoscope, 134:1214-1219, 2024.

Reconstrucción nasal secundaria con injerto costal: caso clínico y revisión de la literatura

Introduction: Secondary rhinoplasty, or reintervention, is a surgery on a previously operated nose, which represents a greater surgical challenge compared to primary rhinoplasty. The ideal is the use of autologous cartilage graft since it meets biocompatibility characteristics and resembles an ideal graft. The costal cartilage is a good alternative since it has characteristics similar to septal cartilage, with the advantage of offering a larger amount of material to work with and it does not deform over time. Clinical case: male, 31 years old, admitted due to a hit to the face with a blunt object. It evidenced complex facial fracture, with Le Fort I components on the right and Le Fort III components on the left, as well as a left naso-orbital-ethmoid fracture. It performs reduction and intermaxillary fixation. It performs nasal reconstruction with a double nasal cartilage graft and bone graft for the back, and septal cartilage graft to construct the columella stem. It plans secondary rhinoplasty with a seventh rib graft correct the saddle nose defect. Outpatient follow-up at 14 and 30 days with favorable cosmetic results. Discussion: This procedure generally gives good results with a low complication rate. In the latest systematic reviews with an average follow-up of 14.4 months (6-96 months) they concluded that in the donor area the most frequent complication was the development of scars in the surgical site with 2.08% (0. 31-4.83%) and pneumothorax was close to 0% (0-0.46%). In the recipient area, the most frequent were graft retraction with 3.05% (1.35-5.19%) and 1.45% (0.34-3.06%) of infection of the recipient area. Conclusion: With the presentation of this clinical case, you can observed that the use of costal cartilage in secondary rhinoplasty is an achievable option, with good results in the short and medium term, in addition to having a low rate of complications, but a team of experienced plastic surgery must perform it.&#x0D; Fecha recepción: noviembre 2022 | Fecha aceptación: febrero

Superiority of the Septal Extension Graft over the Columellar Strut Graft in Primary Rhinoplasty: Improved Long-Term Tip Stability.

Columellar strut grafts and septal extension grafts are commonly used support structures; however, their relative effectiveness remains debated. The purpose of this study was to compare the long-term stability of septal extension grafts to that of columellar strut grafts. A retrospective review of all primary rhinoplasties performed by the senior author (R.J.R.) from 2016 to 2019 was performed. All adult patients undergoing primary open rhinoplasty with at least 1 year of follow-up were included. Revision cases and those in whom rib grafts were used were excluded. Standardized postoperative imaging was assessed at 2 months (early) and at 12 months (long-term) to measure projection/rotation change over time. Univariate and multivariable statistical comparisons were performed. The chart query yielded 133 patients. Of these, 40 patients were treated with a columellar strut and 37 patients were treated with a septal extension graft. Projection loss at 1 year was 4.7% for the columellar strut group compared with 0.2% for the septal extension graft group ( P < 0.0001). On multivariable logistic regression, there was a 5.1-fold increased risk of greater than 4% projection loss when using a columellar strut ( P < 0.005). Mean rotation loss for the columellar strut group was 4.9 degrees compared with 1.3 degrees for the septal extension graft group ( P < 0.0001). The independent effect of columellar strut use resulted in a 2.8-fold increased risk of rotation loss greater than or equal to 5 degrees ( P < 0.05). Septal extension grafts result in effectively no loss of projection and minimal loss in rotation. A small degree of projection and rotation loss can be expected with the use of a columellar strut alone. These long-term graft tendencies should be anticipated and accounted for appropriately. Therapeutic, III.

Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft.

Describe a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof. Retrospective chart review and description of surgical technique. Four patients underwent tumor resection with neurosurgery (2 intraosseous hemangioma, 1 meningioma, and 1 ossifying fibroma), with mean tumor size of 42.6 cubic centimeters on preoperative imaging. All defects involved supraorbital rim and orbital roof. Patients were reconstructed with autogenous osseous rib graft for structure and contour and anterolateral thigh fascia lata (ALTFL) free flap to provide robust vascularity to rib bone and as a barrier between skull base dura and the orbit and/or sinonasal cavities. Two patients underwent resection and reconstruction using minimal access incisions, and two underwent major cranial and skull base resections. All flaps are vascularized via superficial temporal vessels. On postoperative follow-up (mean 33.5 months, range 8-48), all patients report no vision change or diplopia, with excellent contour symmetry to contralateral orbit. Follow-up imaging (mean 29.5 months, range 3-48) demonstrated maintained orbital volume and retention of rib bone graft compared to immediate postoperative imaging. There were no complications related to graft use. Minor complications include 1 patient with cerebrospinal fluid leak managed with lumbar drain placement and 1 patient with mild enophthalmos at 7-month follow-up. We describe a series of patients who underwent a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof with autogenous osseous rib and vascularized ALTFL-free flap with excellent functional and cosmetic outcomes. This can be accomplished using minimal access techniques to minimize patient morbidity. 4 Laryngoscope, 134:654-658, 2024.

Role of Rib Graft for Tip Shaping in Primary Rhinoplasty: A Retrospective Case Series of 30 Patients.

In primary rhinoplasty, use of harvested septal cartilage often precludes the need for rib graft. Nonetheless, there are a number of indications for the use of rib graft in primary rhinoplasty. The purpose of this study was to identify the indications and techniques for rib graft use in primary rhinoplasty. A retrospective review was performed on all patients who underwent primary rhinoplasty performed by a single surgeon over a 5-year period. From these patients, those who required the use of fresh frozen allograft rib cartilage were identified. Medical record review was performed to identify demographics, ethnicity, and history of nasal trauma. Photographic analysis was also performed. Thirty of 638 consecutive primary rhinoplasties (4.7%) required rib graft. Of these, 7 patients (23.3%) demonstrated a history of nasal trauma. Furthermore, a high proportion of primary rhinoplasty patients requiring rib graft were from Asian ( n = 7 [23.3%]), Middle Eastern ( n = 4 [13.3%]), Hispanic ( n = 7 [23.3%]), and African American ( n = 9 [30%]) backgrounds. White patients were in the minority ( n = 2 [6.7%]). All primary rhinoplasties using rib graft implemented a septal extension graft. The present study demonstrates that patients requiring a rib graft in primary rhinoplasty invariably receive a septal extension graft. Furthermore, certain ethnicities associated anatomical characteristics correlated with the need for a rib graft for tip shaping. Ultimately, the use of a septal extension graft in primary rhinoplasty allows for precise and robust projection, rotation, and tip shaping in noses with thick skin, weak cartilaginous framework, and history of nasal trauma. Risk, IV.

Reconstruction of the Irreparable Proximal Scaphoid with Costo-Osteochondral Graft (Rib Graft)

Abstract Background Irreparable proximal pole fractures of the scaphoid remain a real challenge for the treating handsurgeon. Standard salvage options include 4-corner fusion or proximal row carpectomy. These procedures limit the range of motion and have a high rate of conversion to total wrist fusion. The two current biological reconstructive options are the rib graft or the vascularized femoral trochlea osteocartilaginous free flap. In addition, there is the prosthetic semi-replacement arthroplasty using the pyrocarbon adaptive proximal scaphoid implant (APSI). Aims To present our series of patients with non-reconstructable proximal scaphoid nonunion/fracture (not suitable for conventional bone graft reconstruction) who were treated by the rib graft technique. Methods Our case series of 21 patients treated between March 2013 and January 2019 will been presented (median follow-up 29 months). The surgical technique will be described and crucial technical steps explained. The mean age at surgery was 26 years (SD 5.8) and the median time between injury and rib graft surgery was 2 years (IQR 1.7–3.6). The median postoperative follow-up was 29 months (IQR 19.5–42.4). Results All patients returned to their pre-surgical occupation. Significant differences were found in active wrist movements, grip strength, QuickDASH and PRWE pain scores. Union was seen in all 21 patients. The postoperative capitolunate angles were within normal limits. 17/21 patients showed no progessive postoperative osteoarthritic changes, while 4/21 showed slight progression. Progressive ossification of the graft was noted in 14 /21 patients. No donor site complication occurred. One patient failed and underwent excision of the scaphoid and fourcorner fusion 9 months after the rib graft. At the time of revision, the graft was clinically united. We found statistically significant improvements in QuickDASH and PRWE. Conclusions Our results suggest that reconstruction of the irreparable proximal pole scaphoid nonunion with costo-osteochondral graft reconstruction (rib graft) is a reliable and straightforward procedure in this challenging problem.

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.

This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Autograft cranioplasty for skull defects in children

BackgroundCranioplasty is a commonly performed neurosurgical procedure. Cranioplasty is a surgical repair of bony defects in the skull resulting from previous surgery or injury. The pediatric population differs from the adult population as the skull keeps growing and needs special consideration. Aim of the workThis study was conducted to report the experience of the University of Mansoura in children undergoing various bone autografts for cranioplasty over a period of four years. Patients and methodsThis retrospective study of hospital records of children undergoing cranioplasty at the Department of Pediatric Neurosurgery, Mansoura University Hospital between 2018 and 2022. Sex, age, cause of cranial defect, time since craniectomy, type of graft used, bone fixation, cosmetic outcome, wound healing, complications, and treatment of complications were reported. ResultsData from forty-two children were reported in this study. The most common indication for cranioplasty was trauma in twenty two cases 52 % (compound depressed fractures + growing skull fractures + decompressive craniectomy).The most common location was the frontal lobe in fifteen cases 35 %. In 47 %, the split calvarial graft was the most commonly used graft type. The highest percentage of cases showed no complications after follow-up (71 %). ConclusionAutograft cranioplasty in pediatric population had a 71 % success rate in our series with multiple different options including split calavarial graft, rib graft and repositioning of previously stored craniectomised bone flap. The choice between them depends on age of the patient and size of the defect.

Introducing Saddle-Shaped Radix Graft, with a Second Look into the Classic.

An enduringly stable tip graft is the key to achieve successful rhinoplasty cases. However, the intrinsic nature of rib graft warping renders major unpredictability for the long-term outcome. The objective of this study was to detail and validate the use of a radix graft design that is characterized by the dual curved surfaces and beveled margin, which consequently renders a shape similar to a saddle. Twenty-three female patients, ranging in age from 22 to 31 years, completed the study. In all cases, the saddle-shaped radix graft was applied as the essential element for enhancing radix region profile. The complications that arose were collected retrospectively. Three-dimensional stereophotogrammetric evaluations of patients were performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, radix height, and the radius of curvature. Postoperative analysis suggested significant improvement on the aesthetics of the radix region over time, evidenced by the significant increase of radix height (4.33 ± 1.21 mm versus 7.08 ± 1.00 mm), and the reduction of radius of curvature at nasofrontal break over the long term (22.63 ± 2.24 mm versus 13.94 ± 0.98 mm). Other postoperative evaluations, including radix height, tip projection, and nasal length, had significant improvement. The saddle-shaped radix graft effectively augments the radix area and creates an aesthetically pleasant nasofrontal break without causing the elevated radix deformity. It has the merits of anatomical compliance and flexibility when it comes to concomitantly improving the glabella-radix profile for those East Asians with extremely low radix.

D74. A Novel Algorithm for Pediatric Microsurgical Maxillomandibular Reconstruction Using Custom Endoprosthesis

PURPOSE: Treatment of pediatric jaw tumors can cause significant post-resection disfiguration and loss of function. This study evaluates reconstructive outcomes of custom endoprosthesis (CE) compared to non-custom plates(NCP) and introduces a novel algorithm using CE to optimize available vascularized free flaps. METHODS: A retrospective review of all patients undergoing maxillary or mandibular reconstruction between 2016 and 2022 was performed. Review included the following: flap type, complications, and demographics. RESULTS: Our review identified 52 patients who underwent CE/NCP implantation combined with a free fibula flap (n=13), soft-tissue free flap (n=16), iliac crest bone graft (n=5), or rib graft (n=10). Of 38 patients that underwent mandibular resection, 13 received CE and 25 NCP. In the maxillary cohort, five patients received CE and nine received NCP. The CE cohort had a lower average number of revisions than the NCP cohort (.8 vs 2.1, p=0.029) with insignificant differences in complications and donor site morbidity. CONCLUSION: Deviating from NCP, we propose a practice based algorithm for free tissue selection in jaw reconstruction. For maxillary masses, patient age determines the type of free tissue transfer accompanying the CE; while in mandibular masses, the percent of mandible resected and age informs this decision. Improved alignment and less retained hardware may contribute to reducing revisions with CE. Incorporating the CE algorithm into pediatric jaw reconstruction can facilitate improved form and function.

Management of Congenital Aural Atresia and Microtia

Microtia is commonly associated with aural atresia, which will cause cosmetic problems as well as hearing impairment. The management of microtia and aural atresia should improve the aesthetic of the external ear and enhance functional hearing. The reconstruction of the auricle can be performed with autologous rib cartilage or a porous polyethylene framework. Surgeons ideally perform the autologous costal cartilage method at 9 years old or higher considering the development of costal cartilage. For porous polyethylene microtia repair, surgical reconstruction can be performed after 5 years of age. Atresiaplasty can be performed in patients who have normal inner ear function and a well-developed middle ear. The Jahrsdoerfer grading scale is used for assessment of middle ear anatomy and scoring 7 or higher expects good results. The other options for hearing rehabilitation include bone conduction hearing devices or middle ear implants. The surgery for bone conduction devices or middle ear implants can be proposed after 5 years of age. Atresiaplasty is recommended in combination with or after autologous rib graft microtia repair and before porous polyethylene microtia repair. The implantation of the hearing devices should not interfere with auricular reconstruction. It can be performed after autologous rib graft microtia repair or combined with ear elevation.

The etiology, clinical features, and treatment options of hemifacial microsomia.

The second most frequent craniomaxillofacial congenital deformity is hemifacial microsomia (HFM). Patients often accompany short mandible, ear dysplasia, facial nerve, and soft tissue dysplasia. The etiology of HFM is not fully understood. To organize the possible up-to-date information on the etiology, craniofacial phenotypes, and therapeutic alternatives in order to fully comprehend the HFM. Reviewing the potential causes, exploring the clinical features of HFM and summarizing the available treatment options. Vascular malformation, Meckel's cartilage abnormalities, and cranial neural crest cells (CNCCs) abnormalities are three potential etiology hypotheses. The commonly used clinical classification for HFM is OMENS, OMENS-plus, and SAT. Other craniofacial anomalies, like dental defects, and zygomatic deformities, are still not precisely documented in the classification. Patients with moderate phenotypes may not need any treatment from infancy through adulthood. However, patients with severe HFM require to undergo multiple surgeries to address facial asymmetries, such as mandibular distraction osteogenesis (MDO), autologous costochondral rib graft (CCG), orthodontic and orthognathic treatment, and facial soft tissue reconstruction. It is anticipated that etiology research will examine the pathogenic mechanism of HFM. A precise treatment for HFM may be possible with thoroughly documented phenotypes and a pathogenic diagnosis.

Outcomes of Autologous Reconstruction in Comparison with Alloplastic in Microtia Patients

Background: Microtia is a congenital abnormality of the auricle. One of the important comprehensive management of microtia is ear reconstruction. Reconstruction using an auricle framework from autologous material originating from the rib cartilages is still the gold standard. However, currently, some surgeons prefer alloplastic materials which are claimed to reduce morbidity and can be performed at a younger age. Objective: Report a case of a microtia patient who underwent autologous reconstruction followed by a literature search comparing the outcomes of autologous and alloplastic reconstruction. Case: An 11-year-old with grade 3 unilateral microtia who underwent autologous reconstruction surgery using materials from the rib cartilages. Later he complained of pain at the rib grafting site, more than at the surgical wound in the ear. Methods: A literature search based on the clinical question was done in PubMed, EBSCOhost, Cochrane Library, and by hand searching. Results: Three relevant articles that fit the clinical question were included. Autologous reconstruction causes fewer complications, while alloplastic reconstruction is better aesthetically. Further research is needed regarding the quality of life. Conclusion: Auricular reconstruction using autologous material remains the superior material of choice. Alloplastic framework can be an alternative choice with better aesthetic results but greater complication risk.

Outcomes, Concepts, Technical Refinements, and Challenges in the Microvascular Repair of Full-Thickness Nasal Defects.

Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors' microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this article, the authors review stages 2 through 5, using a forehead flap and rib grafts to resurface the nose and build a support framework. The authors examine their complications, long-term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges. Thirty-eight full-thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function, and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor. Repair was completed in 35 of 38 patients. Fifty percent of patients returned an anonymous survey; 85% were very satisfied; 75% declared excellent, very good, or good breathing; 75% used stents never/rarely; 95% appeared normal; and 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair, and 3% poor. A folded radial forearm lining flap, a three-stage full-thickness forehead flap for cover, and a late revision can repair difficult nasal defects, as shown in a large series of patients with long-term follow-up. Therapeutic, IV.

Delayed Reconstruction of Open Multiple Metatarsal Fractures Using Rib Bone Graft after Soft Tissue Coverage with Gracilis Free Flap: Case Report and Literature Commentary

Foot restoration after massive bone and soft tissue loss is a daunting task for surgeons. Existing literature has highlighted various methods of reconstruction. Masquelet technique, use of vascularised and non-vascularized fibular grafts, use of latissimus dorsi, serratus anterior in combination with rib grafts, iliac crest grafts have been described.

The effects of paravertebral nerve blockade on post-operative pain for patients undergoing simultaneous autologous rib grafting and orthognathic surgery: a retrospective pilot study

The effects of paravertebral nerve blockade on post-operative pain for patients undergoing simultaneous autologous rib grafting and orthognathic surgery: a retrospective pilot study

Custom Endoprosthesis: A Versatile Surgical Technique for Optimizing Pediatric Mandibular Reconstruction and Dental Restoration

Goals of pediatric mandibular reconstruction are restoring form, function, and esthetics while providing platforms for dental restoration. Though many techniques recreate the inferior mandibular border, most fail to address form and function in a manner that optimizes dental rehabilitation. We describe a surgical technique using a novel custom endoprosthesis that recapitulates the native mandibular contour while supporting the bone construct in a cephalad direction with a medial ledge facilitating implant placement and oral rehabilitation. This multi-institutional retrospective review at high-volume pediatric craniofacial surgery departments features patients with large mandibular resections warranting custom constructs. Thirteen patients underwent mandibular resection and endoprosthesis reconstruction with either free fibula osteocutaneous flaps (n = 9), soft tissue free flaps without bone graft (n = 2), rib graft (n = 1), or iliac crest bone graft (n = 1). Five patients required revisions for distal flap necrosis, intraoral granuloma, and orocutaneous fistulas; one endoprosthesis required removal. Excellent esthetic and reconstructive outcomes were achieved; however, only 2 patients completed dental restoration given financial constraints. A custom endoprosthesis represents an untapped avenue toward comprehensive pediatric mandibular reconstruction. It shows compatibility with microvascular flaps while optimizing facial contour and bone height for implant placement. Given these advantages, substantial financial barriers to dental restoration should be addressed.

Mandibular Reconstruction with a Custom Endoprosthesis: Optimizing Bone Height and Border Contour

INTRODUCTION: The primary goals of mandibular reconstruction are to restore form, function, and aesthetics while providing a platform suitable for implant placement and oral rehabilitation. We used a novel custom endoprosthesis with complementary cutting guides and predrilled holes to mirror the angle and slope of the native mandible; the upper portion conforms to the bone graft and a medial titanium ledge supports the bone in a cephalad position to optimize distance from the occlusal plane. METHODS: This is an IRB-approved, retrospective chart review at high-volume plastic and maxillofacial surgery departments at pediatric tertiary-care referral centers between January 2018 and June 2021. Patient demographics, comorbidities, mandibular pathology, lesion size, endoprosthesis specifications, postoperative complications, and follow-up time were collected. RESULTS: Eleven patients underwent mandibular resection and custom endoprosthesis reconstruction with free fibula bone osteocutaneous flaps (n = 9), rib graft (n = 1), and iliac crest bone graft (n = 1). Immediate postoperative CT scans confirmed endoprosthesis placement. Five patients (45%) required revisional surgery for distal flap necrosis (n = 1), a small intraoral granuloma (n = 1), and orocutaneous fistulas (n = 3), of which one resulted in endoprosthesis removal. One patient experienced transient foot drop. Excellent cosmetic outcomes were achieved in all patients. Thus far, two patients (18%) have completed dental restoration. CONCLUSION: This custom endoprosthesis represents an untapped avenue toward more comprehensive mandibular reconstruction. It shows compatibility with microvascular flaps as well as skeletally immature and mature patients alike. By optimizing facial contour and bone height, this novel endoprosthesis is an attractive option for patients whose ultimate goal is dental restoration.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes.

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.