TY - JOUR
T1 - A modified approach to extensive oromandibular reconstruction using free fibula flaps
AU - Monaco, Casian
AU - Stranix, John T.
AU - Lee, Z. Hye
AU - Hirsch, David
AU - Levine, Jamie P.
AU - Saadeh, Pierre B.
PY - 2017
Y1 - 2017
N2 - In select patients with advanced disease resulting in large composite tissue defects, consideration is often given to multiple flap reconstruction. The authors propose an alternative option. Using virtual surgical planning the authors demonstrate how modest sacrifice in projection translates into a substantial decrease in the volume and surface area of soft tissue needed, in turn maximizing soft tissue coverage with a single fibula free flap. The authors used 3-dimensional virtual surgery to simulate angle-to-angle reconstructions using free fibula flaps. The reference 3-segment reconstruction was done using symphyseal projection to the plane perpendicular to the anterior nasal spine, a customary landmark. Additional simulations were then performed using recessed projections 0.5 mm, 1 cm, 1.5 cm, and 2 cm posterior to anterior nasal spine plane. Program analytics were used to calculate the surface area and volume of the floor of mouth. With projection recessed by 1 cm, surface area decreased 22% to 14 cm2. With projection recessed by 2 cm, surface area decreased 44% to 10 cm2. With a 3-segment construct converted to a 2-segment construct, surface area decreased 22% to 14 cm2. This demonstrates for the first time an official analysis of an intraoperative modification that sacrifices little and gains a lot. Ultimately, 1 compound flap can be used in extensive reconstructions with increased confidence that it will not be overly stressed.
AB - In select patients with advanced disease resulting in large composite tissue defects, consideration is often given to multiple flap reconstruction. The authors propose an alternative option. Using virtual surgical planning the authors demonstrate how modest sacrifice in projection translates into a substantial decrease in the volume and surface area of soft tissue needed, in turn maximizing soft tissue coverage with a single fibula free flap. The authors used 3-dimensional virtual surgery to simulate angle-to-angle reconstructions using free fibula flaps. The reference 3-segment reconstruction was done using symphyseal projection to the plane perpendicular to the anterior nasal spine, a customary landmark. Additional simulations were then performed using recessed projections 0.5 mm, 1 cm, 1.5 cm, and 2 cm posterior to anterior nasal spine plane. Program analytics were used to calculate the surface area and volume of the floor of mouth. With projection recessed by 1 cm, surface area decreased 22% to 14 cm2. With projection recessed by 2 cm, surface area decreased 44% to 10 cm2. With a 3-segment construct converted to a 2-segment construct, surface area decreased 22% to 14 cm2. This demonstrates for the first time an official analysis of an intraoperative modification that sacrifices little and gains a lot. Ultimately, 1 compound flap can be used in extensive reconstructions with increased confidence that it will not be overly stressed.
KW - Collapsing in of mandible reconstruction
KW - Free fibula flap
KW - Mandible reconstruction
KW - Virtual surgical planning
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U2 - 10.1097/SCS.0000000000003228
DO - 10.1097/SCS.0000000000003228
M3 - Article
C2 - 27977482
AN - SCOPUS:85004073481
SN - 1049-2275
VL - 28
SP - 93
EP - 96
JO - Journal of Craniofacial Surgery
JF - Journal of Craniofacial Surgery
IS - 1
ER -