Microsurgical reconstruction of the maxilla: Algorithm and concepts
Microsurgical reconstruction of the maxilla: Algorithm and concepts
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DOI：
10.1016/j.bjps.2014.12.002
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发表时间：
2015-05-01
影响因子：
2.7
通讯作者：
Andresen, Carolina
中科院分区：
文献类型：
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作者：
Costa, Horacio;Zenha, Horacio;Andresen, Carolina
简介：本文的主要目的是强调自由组织移植是三维（3D）上颌骨重建的首选方法，特别是在为腭和上颌骨弓重建提供足够的骨骼以及随后的种植体固位假体方面。为了实现这一点，尽可能选择肌骨游离髂嵴作为重建算法和游离皮瓣器械的首选。提出了一种新的上颌骨切除分类和重建算法。讨论了随着时间的推移所完成的技术修改和改进，考虑到腭，牙种植体和假体，鼻侧壁，颅底和硬脑膜，以及受体血管。我们介绍了资深作者过去24年的经验（H. C.）材料和方法：作者报告并分析了24年来54例患者（30例男性和24例女性）57个面中部缺损的经验。共分析了57例上颌骨缺损-分类为I类（有限上颌骨切除术）= 12例、II类（上颌骨次全切除术）= 15例、III类（上颌骨全切除术）= 19例和IV类（眶上颌切除术）= 11例-分析了性别、年龄、肿瘤复发、游离瓣、重建和坏死。此外，功能的结果进行了评价，饮食，语音，地球仪的位置和视力，而美学的结果进行了评价，患者和外科医生scores.Results：共52个自由皮瓣进行了47例，三名患者进行了两次手术，和其他两名患者需要两个顺序连接的流通皮瓣。游离皮瓣成活率为96%，2例皮瓣全部丢失（4%）。其他7例患者安装了一个软组织保留obtobilator prosthesis.Conclusions：显微外科血管化骨肌皮瓣游离移植实际上是重建复杂的缺陷后上颌骨切除术的金标准。该算法是基于上颌骨解剖功能缺损的，便于皮瓣选择，这是必须的。(C)2015年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Introduction: The main purpose of this article is to highlight free tissue transfers as the first-choice method for three-dimensional (3D) maxillary reconstruction, particularly in providing enough bone for palate and maxillary arch reconstruction and consequently an implant-retained prosthesis. To achieve this, the myosseous free iliac crest was selected whenever possible as the first choice inside the reconstructive algorithm and free flap armamentarium. A new maxillectomy classification and algorithm reconstruction are proposed.Technical modifications and improvements accomplished over time are discussed, considering palate, dental implants and prosthesis, nasal sidewall, cranial base and dura, as well as recipient vessels.We present functional and aesthetic outcomes of the senior author's past 24-year experience (H. C.) with complex midface reconstructions.Material and methods: The authors report and analyse a 24-year experience with 57 midface defects in 54 patients (30 males and 24 females). A total of 57 maxillary defects - classified as Class I (limited maxillectomy) = 12, Class II (subtotal maxillectomy) = 15, Class III (total maxillectomy) = 19 and Class IV (orbitomaxillectomy) = 11 - were analysed regarding sex, age, tumour recurrence, free flap, reconstruction and necrosis. In addition, functional outcomes were evaluated regarding diet, speech, globe position and vision, while aesthetic outcomes were evaluated by patient and surgeon scores.Results: A total of 52 free flaps were performed in 47 patients; three patients were operated upon twice; and two other patients needed two sequentially linked flow-through flaps. The free flap survival was 96% with two total flap losses (4%). The other seven patients were fitted with a soft tissue-retained obturator prosthesis.Conclusions: Microsurgical vascularised osteomyocutaneous free flaps are actually the gold standard for reconstruction of complex defects following maxillectomy. This algorithm is based on the anatomofunctional defect of the maxilla and it facilitates flap selection, which is a must. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.