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Defect Reconstruction (defect + reconstruction)
Selected AbstractsFunctional reconstruction of the lateral face after ablative tumor resection: Use of free muscle and musculocutaneous flapsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2001Tugrul Maral MD Abstract Background Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either due to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. Methods We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects and facial palsy. Defect reconstruction and facial reanimation was accomplished in one stage through functional muscle transplantation. Results Follow-up of more than 1 year showed good symmetry at rest and reanimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the transplanted muscle, developed significant muscle contracture and binding of the cheek skin. Conclusions Every effort should be made to optimize the functional and cosmetic outcomes of neurovascular muscle transfers through precise planning and careful execution of the intricate details of the surgical technique for muscle transplantation. © 2001 John Wiley & Sons, Inc. Head Neck 23: 836,843, 2001. [source] Functional reconstruction of complex lip and cheek defect with free composite anterolateral thigh flap and vascularized fascia,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2008Yur-Ren Kuo MD Abstract Background. Extensive composite defects involving the lip and cheek present difficult reconstructive challenges. This study presents a technique using anterolateral thigh (ALT) flaps with vascularized fascia for large complex oral sphincter defect reconstruction. Methods. Fifteen patients who had undergone oral cancer ablation were enrolled in the study. The average area of intraoral lining and cheek,lip skin defects was 96.9 cm2. Upper-lip defects ranged 0% to 60%, and lower-lip defects ranged 20% to 80%. Skin and intraoral lining defects were replaced by an ALT fasciacutaneous flap. The vascularized fascia of the flap was used to provide lip suspension. Results. Flap survival was 100%. All but 1 patient had good static suspension. Nine patients had adequate oral competence without drooling, but 6 had occasional oral incontinence. All patients achieved an acceptable appearance. Conclusions. For extensive cheek,lip composite defects, ALT flap together with vascularized fascia has proven to be a useful option for functional reconstruction. © 2008 Wiley Periodicals, Inc. Head Neck 2008 [source] The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defectJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 7 2006Ronald W. Lindsey Abstract The authors developed a novel technique for the reconstruction of large segmental long bone defects using a cylindrical titanium mesh cage (CTMC). Although the initial clinical reports have been favorable, the CTMC technique has yet to be validated in a clinically relevant large animal model, which is the purpose of this study. Under general anesthesia, a unilateral, 3-cm mid-diaphyseal segmental defect was created in the femur of an adult canine. The defect reconstruction technique consisted of a CTMC that was packed and surrounded with a standard volume of morselized canine cancellous allograft and canine demineralized bone matrix. The limb was stabilized with a reamed titanium intramedullary nail. Animals were distributed into four experimental groups: in Groups A, B, and C (six dogs each), defects were CTMC reconstructed, and the animals euthanized at 6, 12, and 18 weeks, respectively; in Group D (three dogs), the same defect reconstruction was performed but without a CTMC, and the animals were euthanized at 18 weeks. The femurs were harvested and analyzed by gross inspection, plain radiography, computed tomography (CT), and single photon emission computed tomography (SPECT). The femurs were mechanically tested in axial torsion to failure; two randomly selected defect femurs from each group were analyzed histologically. Groups A, B, and C specimens gross inspection, plain radiography, and CT, demonstrated bony restoration of the defect, and SPECT confirmed sustained biological activity throughout the CTMC. Compared to the contralateral femur, the 6-, 12-, and 18-week mean defect torsional stiffness was 44.4, 45.7, and 72.5%, respectively; the mean torsional strength was 51.0, 73.6, and 83.4%, respectively. Histology documented new bone formation spanning the defect. Conversely, Group D specimens (without CTMC) demonstrated no meaningful bone formation, biologic activity, or mechanical integrity at 18 weeks. The CTMC technique facilitated healing of a canine femur segmental defect model, while the same technique without a cage did not. The CTMC technique may be a viable alternative for the treatment of segmental long bone defects. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:1438,1453, 2006 [source] Outcomes following temporal bone resection,,THE LARYNGOSCOPE, Issue 8 2010Nichole R. Dean DO Abstract Objectives/Hypothesis: To evaluate survival outcomes in patients undergoing temporal bone resection. Study Design: Retrospective review. Methods: From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. Results: The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1,28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. Conclusions: Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival. Laryngoscope, 2010 [source] Anomalous arterial supply to the muscles in a combined latissimus dorsi and serratus anterior flapCLINICAL ANATOMY, Issue 4 2004A.S. Halim Abstract The combined latissimus dorsi and serratus anterior flap has been employed for large defect reconstruction and has been shown to be reliable. These flaps are based on the subscapular-thoracodorsal vascular pedicle that usually supplies both muscles. In the case reported, serratus anterior possessed an anomalous arterial supply totally independent of the subscapular pedicle. The latissimus dorsi and serratus anterior muscles were used as a combined flap to reconstruct a massive thigh defect. The combined flap required two arterial anastomoses. Clin. Anat. 17:358,359, 2004. © 2004 Wiley-Liss, Inc. [source] Maxillary reconstruction using anterolateral thigh flap and bone graftsMICROSURGERY, Issue 6 2009Bernardo Bianchi M.D. Background: Loss of the maxilla and midfacial bone buttresses after tumor resections can lead to severe functional and esthetic consequences. The loss of palate function may lead to oro-nasal communication, nasal speech, and oral intake difficulties. Several techniques have been proposed for maxillary defects reconstruction including prosthesis, locoregional flaps, or free flaps. The authors propose the use of anterolateral thigh free flap and iliac crest, or calvaria bone graft association for reconstruction of this kind of defects. Methods: Between November 2003 and June 2007, eight patients underwent maxillectomies, with preservation of the orbital contents and simultaneous reconstruction using this technique. Results: All the flaps were harvested and transplanted successfully. No major complication occurred and only one patient developed a palatal dehiscence with partial necrosis of the skin of the flap. There were no complications at the donor sites. Speech was assessed as normal in five patients, intelligible in two patients, and poor in one patient. Six patients returned to normal diets, while two patients were restricted to soft diets. The esthetic results were evaluated by the patients themselves as good (in five cases) and acceptable (in two cases). In the remaining case, the esthetic result was deemed to be poor, due to ectropion and poor color matching of the skin used for the external coverage. Conclusion: The good results obtained using this technique encourage the choice of the association of anterolateral thigh and bone grafts for reconstructing maxillary complex defects. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source] | |||||||||||||