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Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus

The run-through technique involves inserting the reconstruction plate through a two-island flap. Initially, the plate is positioned for fitting to the mandible but subsequently removed. The plate is penetrated into a layer of deep fascia through the rectus abdominis muscle. Finally, part of the reconstruction plate that is penetrated through the flap is fixed to the mandibular bone. Any surplus flap is denuded and buried under the skin of the neck.
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Related In: Results  -  Collection


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fig2: The run-through technique involves inserting the reconstruction plate through a two-island flap. Initially, the plate is positioned for fitting to the mandible but subsequently removed. The plate is penetrated into a layer of deep fascia through the rectus abdominis muscle. Finally, part of the reconstruction plate that is penetrated through the flap is fixed to the mandibular bone. Any surplus flap is denuded and buried under the skin of the neck.

Mentions: For example, the risk of plate exposure can be reduced by wrapping flaps around the reconstruction plate to improve its fit and thereby reduce skin tension and dead space. In our institutions, we have adopted the “wrap-around” and “run-through” techniques in mandibular reconstructions performed using rectus abdominis musculocutaneous flaps. The wrap-around technique involves positioning the flap under the reconstruction plate and then wrapping the plate with muscle, fascia, or denuded island flaps (Figure 1) [7]. The run-through technique (Figure 2), which is used in cases where both the skin of the neck and oral mucosa (e.g., the tongue or mandible) are resected, involves inserting the reconstruction plate through a two-island flap (Figure 3) so that the plate is always covered with skin.


Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

The run-through technique involves inserting the reconstruction plate through a two-island flap. Initially, the plate is positioned for fitting to the mandible but subsequently removed. The plate is penetrated into a layer of deep fascia through the rectus abdominis muscle. Finally, part of the reconstruction plate that is penetrated through the flap is fixed to the mandibular bone. Any surplus flap is denuded and buried under the skin of the neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150385&req=5

fig2: The run-through technique involves inserting the reconstruction plate through a two-island flap. Initially, the plate is positioned for fitting to the mandible but subsequently removed. The plate is penetrated into a layer of deep fascia through the rectus abdominis muscle. Finally, part of the reconstruction plate that is penetrated through the flap is fixed to the mandibular bone. Any surplus flap is denuded and buried under the skin of the neck.
Mentions: For example, the risk of plate exposure can be reduced by wrapping flaps around the reconstruction plate to improve its fit and thereby reduce skin tension and dead space. In our institutions, we have adopted the “wrap-around” and “run-through” techniques in mandibular reconstructions performed using rectus abdominis musculocutaneous flaps. The wrap-around technique involves positioning the flap under the reconstruction plate and then wrapping the plate with muscle, fascia, or denuded island flaps (Figure 1) [7]. The run-through technique (Figure 2), which is used in cases where both the skin of the neck and oral mucosa (e.g., the tongue or mandible) are resected, involves inserting the reconstruction plate through a two-island flap (Figure 3) so that the plate is always covered with skin.

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus