Analysis of intraoral microvascular anastomosis in maxillofacial defects reconstruction

Zhang, Hongyu; Shao, Zhang; Jia, Jun; Liu, Bing; Bu, Lin‐Lin

doi:10.1016/j.jcms.2023.01.008

Cited by 9 publications

(7 citation statements)

References 82 publications

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“…Importantly, it is worth highlighting that these failures were not linked to the anastomosis technique itself, but rather the postoperative complications observed were consistent with those commonly encountered in conventional free flap procedures [32,33]. Furthermore, in line with the findings in the existing literature, it appears that intraoral anastomosis techniques exhibit suitability for a wide range of free flaps, without any distinct preferences among them [10,12]. In the remaining 127 cases, a high rate of success was observed using a diverse range of free flaps.…”

Section: Discussionsupporting

confidence: 69%

“…These findings align with the observations made in Gaggl's study [13] and might pose a significant advantage over extraoral anastomoses. Conversely, it is important to acknowledge that the preparation of vessels through an intraoral approach has demonstrated greater complexity compared with the conventional method [12]. Moreover, it is essential to consider that in cases of secondary reconstruction following prior neck dissection, the facial vessels may have been ligated, rendering intraoral anastomosis unfeasible in such scenarios.…”

Section: Discussionmentioning

confidence: 99%

“…In instances involving flaps with a short pedicle and requiring extraoral anastomosis, techniques for pedicle elongation, such as interposition vein grafting, become necessary. However, it is essential to recognize that this procedure carries specific risks that can impact the flap's overall viability and success [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is advisable to visualize these vessels, at the very least, using Doppler ultrasonography before proceeding with surgery. Furthermore, scars in the vestibular mucosa have been associated with a more intricate process of vessel preparation [12,13]. It is important to consider that patients with limited mouth opening and/or temporomandibular joint dysfunction may not be ideal candidates for this approach [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…From a recent literature review, 122 patients with maxillofacial defects were treated between 2009 and 2021 with flaps nourished by intraoral anastomoses [12]. Nonetheless, it is worth noting that the existing literature on intraoral anastomoses of free flaps primarily emphasizes secondary reconstruction and includes a substantial number of patients with benign lesions [10,13,16,19,20].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Intraoral Microvascular Anastomosis in Immediate Free Flap Reconstruction for Midfacial Tumor Defects: A Retrospective Multicenter Study

Kämmerer,

Tavakoli,

Gaggl

et al. 2023

JCM

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(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free flaps in midfacial reconstruction have been executed using cervical vessels. However, this approach necessitates neck access, resulting in extraoral scars and a substantial pedicle length. In light of these considerations, using intraoral anastomoses via the facial vessels emerges as a promising alternative. This retrospective multicentric study aims to provide a comprehensive account of immediate midface reconstruction through intraoral anastomoses. (2) Methods: Between 2020 and 2023, patients were included who underwent intraoral resection of midface/orbit segments (Brown Classes I-VI) as a result of malignant diseases. In all cases, immediate reconstruction was accomplished by utilizing the facial vessels through an intraoral approach. Outcome criteria were identification of vessels, parotid duct or facial nerve damage, success of vascular anastomoses, and flap survival. (3) Results: A total of 117 patients with 132 flaps (91 osseous and 41 cutaneous) were included. The intraoral preparation of facial vessels was successfully completed in less than 1 h, and no complications related to the dissection or anastomoses were observed. In two cases, the vessel diameter was insufficient to facilitate anastomoses, necessitating adopting an extraoral approach. During a follow-up period of 48 months, two osseous flaps were lost, accounting for a 1.5% loss rate out of 132 flaps used. Additionally, 3 flaps experienced partial loss, including a skin island of a scapula, the border zone of a femur, and a rectus flap, resulting in a 2.3% partial loss rate out of 130 flaps utilized. (4) Conclusions: This case series underscores the feasibility of employing intraoral anastomoses for immediate complex midface reconstruction following oncological resection. This approach is particularly advantageous for flaps with shorter pedicles, as it helps mitigate external scarring and minimizes the risk of facial nerve injury.

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