Which is better for reconstruction of tongue and floor of mouth: comparison of the medial sural...

1300 21st ICOMS 2013 - Abstracts: Oral Papers

T19.OR047

The fibula flap in head-neck reconstruction: audit of 63 consecutive cases, and role of imaging

N. Vig ∗ , B. Visavadia, M. Shorafa, M. Gilhooly

NWLH NHS Trust, United Kingdom

The fibula flap is an established ‘workhorse’ for mandibular and maxillary defects. We presentresults of an audit of 63 consecutive cases of the fibula free flap for reconstruction in head-neck surgeryfrom one of the largest UK OMFS centres, performed over a 6-year period. The majority of cases(72%) were performed for SCC and the focus of the paper includes discussion of complications andsuccess rate (94%), and explores the role of radiotherapy and co-morbidities in predicting failure forthis flap. The importance of appropriate imaging modalities is highlighted, with emphasis on the rolethe MRA (magnetic resonance angiography) in flap selection over other possible modalities. Qualityof Life implications of this flap are also raised, following a small survey of recent patients (n = 19)using the Foot and Ankle Disability Index (FADI), which demonstrates that the impact of the fibulaflap is generally minimal on day-to-day function, and is an acceptable and satisfactory donor site.

http://dx.doi.org/10.1016/j.ijom.2013.07.431

T19.OR048

Total 3D planned mandibular reconstructions using CAD–CAM reconstruction plates andguided implant placement in free vascularized fibula grafts

M. Witjes ∗ , G. Raghoebar, L. Lahoda, J. Roodenburg, R. Schepers

University Medical Center Groningen, Netherlands

Background and objectives: New developments in 3D computerized planning now allow forthe inclusion of precise dental implant placement in the fibula as well as pre-operatively CAD–CAMproduced reconstruction plates. In the research phase for the development of a new commerciallyavailable CAD CAM produced reconstruction plate a cadaver and clinical study was performed.Several items were studied: (1) The development of a new design of a 3D printed guide allowingimplant insertion, pre drilling of screw holes as well as segmentation of the fibula. (2) The precisionof placement of a CAD CAM produced reconstruction plate, dental implants and the segmentation offibula bone.

Methods: Complex fibula reconstructions of large mandibular C-defects were performed incadavers and a patient using a new protocol. With pre-operative computer planning the originalshape of the mandible was obtained by segmentation of the fibula. Also the optimal position of theimplants was located and finally the reconstruction plate was designed. 3D planning of the plateallows placement of the screw holes free from the implant location. One guide for implant placement,pre-drilling of the screw holes in the fibula and segmentation was designed. All procedures wereperformed while the fibula was still attached to the vessels in the lower leg.

Results: This protocol resulted in a deviation of less than 1 mm of the reconstruction comparedto the plan! Pre drilling of screw holes in the fibula did not interfere with implant placement. TheCAD CAM plate had an excellent fit. It was possible to plan new screw holes around pre-existingholes from previously inserted plates.

Conclusions: There is a clear advantage of using 3D planned guides for implant placement,segmentation and pre drilling of screw holes. CAD CAM produced plates have an excellent fit.

Key words: mandibular reconstruction; 3D printing; reconstruction plate; dental implants

http://dx.doi.org/10.1016/j.ijom.2013.07.432

T19.OR049

Which is better for reconstruction of tongue and floor of mouth: comparison of the medial suralartery flap with radial forearm flap, anterolateral thigh flap and lateral arm flap

Y.N. Wu ∗ , Y. Yuan, H.M. Wu, J.H. Ye, X.M. Song, J. Cheng, X. Ding, J. Chen, J.I.E. Yao, S.Z.Xing

Department of Oral and Maxillofacial Surgery, School of Stomatology, Nanjing Medical University,China

Objective: To compare the application of medial sural artery perforator flap, lateral arm flap,anterolateral thigh flap and forearm flap in reconstruction of defects in the tongue and floor of mouthfollowing ablative oncological surgery.

Methods: The study included 64 patients (39 male, 25 female, mean ages 57.3, and range 38C71 years). 9 medial sural artery perforator flaps, 19 lateral arm flaps, 13 anterolateral thigh flaps and23 forearm flaps were harvested. Flap sizes ranging from 5.6 to 8.11 cm.

Results: 60 (93.75%) flaps healed without venous insufficiency.Conclusions: Each flap has its own advantage. Compared with the radial artery, the medial

sural artery, posterior radial collateral artery, and descending branch of the lateral circumflex femoralartery is a nonessential vessel. Medial sural artery perforator flap, lateral arm flap and anterolateralthigh flap have the advantages including anatomically reliable vascular supply; accessible donor site;and the aesthetic quality of donor tissue; primary closure can be achieved in most patients. Thedisadvantages of lateral arm flap and anterolateral thigh flap are the relatively smaller vessel sizeand thicker subcutaneous tissue, while for medial sural artery flap, the thickness and volume can beadjusted to accommodate the extent of the defect.

http://dx.doi.org/10.1016/j.ijom.2013.07.433

T19.OR050

Pure soft tissue flaps for maxillectomy defects reconstruction with favourable functional andsatisfaction outcomes, case series of the Boston Medical Center

W. Zaid ∗ , A. Salama

Boston Medical Center, United States

Purpose: The aim of this abstract to share our experience utilizing pure soft tissue flaps inmaxillectomy defects reconstruction.

Patients and methods: Case series of patients that underwent Maxillectomies with simultaneoussoft tissue free flaps who meet the inclusion criteria answered a questionnaire during a clinical followup visit or through a telephone conversation.

Conclusion: Analysis of the answered questionnaire showed favourable functional (Speech andswallowing) outcomes and a great satisfaction with the soft tissue free flap reconstructive option.

http://dx.doi.org/10.1016/j.ijom.2013.07.434