Retrospective Clinical Analysis of Double Free-Flap Reconstruction of maxillofacial defect

Poster Session

such example is damage to the globe requiring enucle-

ation. Reconstruction of these injuries with prosthesescan be complex and requires a multidisciplinary

approach often involving Ophthalmology, Occuloplas-

tics, Oral and Maxillofacial Surgery, and Maxillofacial

Prosthodontics. In the Wounded Warrior population,

one complication we have encountered is the loss of

orbital and facial volume that compromises the support

for a globe prosthesis as well as the cosmetic outcome.

Our group has overcome this challenge utilizing autolo-gous fat transplantation.

Methods: A case review was completed following

multispecialty intervention in the case of a traumatic

globe injury resulting in loss of the globe. Specialties/

Subspecialties in the collaborative effort include Ophthal-

mology, Occuloplastic, Oral and Maxillofacial Surgery,

and Maxillofacial Prosthodontics. Data analyzed included

mode of injury, amount of fat transferred, number of pro-cedures and a review of complications. The following

Wounded Warrior was treated at Walter Reed National

Military Medical Center in Bethesda, MD.

Results: One Wounded Warrior underwent two autol-

ogous lipotransfers to the periorbital region following

initial healing from his enucleation. Orbital architecture

and overall facial volume were successfully improved

via autologous lipotransfer to the periorbital, infraorbitaland nasolabial regions. The patient had objective

improvement of prosthesis fit as well as subjective

improvement in overall cosmesis. There were no signifi-

cant complications to report from the procedures.

Conclusions: Autologous fat grafting has proven to be

effective in the treatment of scars by clinically improving

contour deformities, softening texture and adapting hue

to the uninjured adjacent skin. Adipose tissue can be anabundant source of pluripotent stem cells. Fat transfer

can be designed to recontour scars, soften and reduce hy-

pertrophic deformities such as induration, involutions,

and deep furrow, and as in this report, treat an orbit

with periorbital hollowing. This case presents a multidis-

ciplinary approach to the restoration of the periorbital

region after orbital enucleation, utilizing an ocular pros-

thesis and lipotransfer.

References:

1. Thach AB, Johnson AJ, Carroll RB, et al. Severe eye injuries in the

war in Iraq, 2003–2005. Ophthalmology 2008; 115:377–382.

2. Cetinkaya A, Devoto MH. Periocular fat grafting: indications and

techniques. Curr Opin Ophthalmol 2013;24(5):494-9.

POSTER 262Retrospective Clinical Analysis of DoubleFree-Flap Reconstruction of maxillofacialdefect

K. Sung: School of Dentistry, Seoul National University,

J. Ho Lee, M. J. Kim, M. Hoon, S. KIM

AAOMS � 2014

Objective: The purpose of this study was to analyze

the result of double free-flap reconstruction cases retro-spectively.

Patients and Methods: A total of 23 patients under-

went double free-flap reconstruction between 1999 to

2014 at Seoul National University Dental Hospital

(SNUDH). There were 13 men and 10 women. We exam-

ined Primary pathology, donor site of free flap, type of pri-

mary/secondary reconstruction, success rate, follow-up

period, operate time.Results: Patient age ranged from14 to 76withmean age

of 50 years, andmean post operative follow-up period was

56.1 months. Most common primary pathology was squa-

mous cell carcinoma (56.5%), followed by adenoid cystic

carcinoma (13.0%). 34.8% of the patients received radial

forearm free flap for reconstruction while 26.1% and

23.9% of patients received latissimus dorsi free flap and

fibular free flap, respectively. Remaining patients receivedserratus anterior free flap (8.7%) and rectus abdominis free

flap (6.5%). The most frequently used combination of free

flapswas that of radial forearm free flap and fibular free flap

(21.7%), followed by combination of latissimus dorsi free

flap and radial forearm free flap(17.4%) and combination

of latissimus dorsi free flap and fibular free flap(17.4%).

Among the 23cases included in this study, 19were primary

reconstruction and 4 were secondary reconstruction. Themean operation time was 15 hours. Local complications

included dehiscence (8 cases) and infection (1 case). Suc-

cess rate of double free-flap was about 91%.

Conclusion: Patients who had extensive defects after

ablation have no optional solution. Double free-flaps

reconstruction was a good alternative if single free-flaps

are not applicable. Double free-flaps were an indication

in case of composite tissue requirement.

References:

1. Andrades P, Bohannon IA, Baranano CF, Wax MK, Rosenthal E. In-

dications and outcomes of double free flaps in head and neck recon-

struction. Microsurgery 2009;29:171–177.

2. Kalavrezos N, Bhandari R. Current trends and future perspectives in

the surgical management of oral cancer. Oral Oncol 2010;46:429–432.

POSTER 2630steogenic potential of the osteogenicmatrix cell sheets in maxillofacialregeneration

Y. Ueyama: Nara Medical University, T. Yagyuu, M. Maeda,

T. Kirita

Regenerationofmaxillofacial bonedefects suchasmaxil-

lary alveolar clefts and bone resorption resulting frommar-ginal periodontitis pose a significant clinical challenge. We

focused on the new cell transplantation technique in

which bone marrow-derived mesenchymal stem cells

(BMSCs) were cultured as cell sheets with osteogenic

e-199