No abstract

Introduction: Use of patient specific Polymethyl methacrylate (PMMA) implants for the reconstruction of cranial defects has become a standard practice with excellent long-term results. However, for the reconstruction of midface and mandibular osseous defects other alloplastic materials are preferred but their use is limited due to high cost. This is a report of our experience with the use of low-cost patient specific PMMA implants fabricated using 3D printed moulds in the reconstruction of osseous defects involving different areas of the facial skeleton not limited to cranium. Methods: The 25 consecutive patients with craniofacial osseous defects who underwent reconstruction using customized PMMA implants were analyzed. All PMMA implants were fabricated intraoperatively with the use of 3D printed flexible moulds or templates.Results: A total of 34 implants were used in 25 consecutive patients. Out of 34 implants 25 were used for midface and mandibular osseous defects. Most common etiology was posttraumatic deformity (n ¼ 19) followed by tumor (n ¼ 3), craniofacial anomalies (n ¼ 2) and post-craniotomy (n ¼ 1). One patient out of 25 (n ¼ 1) had postoperative implant exposure. The follow-up was ranged from 3 to 19 months with an average of 12 months. The aesthetic outcome was found to be good to excellent with mean visual analogue score of 4.08. Conclusions: Polymethyl methacrylate implants fabricated intraoperatively using 3D printed moulds provide accurate and precise reconstruction at an exceptionally low cost. PMMA has an excellent moulding property with low infection rates. As shown in our study its application may be easily extended to all areas of the craniofacial skeleton.

Objective: Vessel-depleted neck is a challenge for the microvascular surgeon planning for a free tissue transfer. We consider vessel-compromised neck as a situation where a patient has undergone previous neck dissection along with postoperative radiotherapy and has planned for free tissue transfer on the same side for second primary/recurrence. This study describes our experience of successful free tissue transfer in the vessel-compromised neck and the techniques adopted for the same. We also propose an algorithm for vessel-compromised neck. Methods: All patients who required a free flap in the head and neck region after previous neck dissection and radiation in the last 4 years were included in this study. These patients had either recurrence or second primary requiring re-resection and free flap reconstruction. Technical operative data including the availability of recipient vessels, the need to access the contralateral side of the neck, and anastomosis sites were logged in the database. Results: Of the 359 free flaps, 38 patients were classified as having vessel-compromised neck. During the first surgery, 19 out of 38 patients underwent reconstruction in the form of free flap, 15 had wide local excision (primary closure) and neck dissection, while 4 patients underwent reconstruction with local flaps. In the second surgery, the recipient vessels were chosen on the ipsilateral side in 22 patients and contralateral in 16 patients. These flaps were anastomosed with ipsilateral superior thyroid vessels (n = 14), contralateral superior thyroid vessels (n = 16), ipsilateral superficial temporal vessels (n = 6), and ipsilateral facial vessels (n = 2). One patient had partial flap loss that was managed with local flap. Conclusion: Vessel-compromised neck is not a contraindication for free tissue transfer. Excellent results can be achieved by careful flap selection and choosing the best recipient vessel nearby using the algorithm proposed in the study. Ethics Approval and Consent to Participate:The study is in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Introduction:In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage.Materials and Methods:Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap.Observations and Results:Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation.Conclusion:The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.