Prognosis as a determinant of free flap utilization for reconstruction of the lateral mandibular defect

Deleyiannis, Frederic W.‐B.; Lee, Edward; Gastman, Brian; Nguyen, David; Russavage, James M.; Manders, Ernest K.; Ferris, Robert L.; Myers, Eugene N.; Johnson, Jonas T.

doi:10.1002/hed.20463

Cited by 17 publications

(4 citation statements)

References 36 publications

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“…Full‐text copies of 54 manuscripts were retrieved. Data was not retrieved from 37 of the 54 full‐text papers for meeting the following exclusion criteria; not using free flaps ( n = 2), not reporting a failure rate ( n = 7), using only 1 free flap harvest site ( n = 6), using an uncommon combination of free flaps ( n = 1), studying cadavers ( n = 1), studying animals ( n = 1), not reporting at least 1 failure ( n = 18), or containing data from another larger study ( n = 1) . Seventeen studies underwent data extraction and are reported in Table …”

Section: Resultsmentioning

confidence: 99%

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta‐analysis

et al. 2015

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Section: Resultsmentioning

confidence: 99%

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta‐analysis

et al. 2015

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“…There were 81 papers (16, 24, 29, 30, 31, 33, 38, 47, 49, 53, 55, 57, 63, 65, 66, 69, 71, 73, 75, 76, 81, 84, 89, 91, 95, 97, 99, 100, 103, 104, 107-109, 111-116, 120, 121, 124, 125, 130, 132-134, 137, 140 145-150, 154, 158, 163, 165, 166, 168, 170-173, 180, 184, 185, 188, 194-197, 202, 203, 205, 210, 212, 221, 222, 229) 98, 101, 106, 110, 110, 117-119, 122, 123, 126-129, 131, 135, 138, 139, 141, 143, 151, 153, 156, 159-161, 164, 167, 169, 179, 182, 183, 187, 190, 192, 193, 199, 200, 204, 206, 207, 209, 212, 214, 216, 218, 220, 223, 225, 227, 228) also reconstructed the condyle, compared with 1.6% (6/373) for the iliac crest (13,15,19,60,77,79,86,87,98,105,155,157,161,177,178,183,201,211,212,227 …”

Section: Classificationmentioning

confidence: 98%

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Brown

Lowe

Kanatas³

et al. 2017

British Journal of Oral and Maxillofacial Surgery

137

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A systematic review was undertaken to explore the mandibular reconstruction techniques and outcomes, using composite free flaps.A total of 9499 mandibular defects were reconstructed with 6178 fibulas, 1380 iliac crests, 1127 composite radials, 709 scapulas, 63 serratus anterior and rib, 32 metatarsals and 10 lateral arm flaps including humerus. The flap failure rate was higher for the iliac crest at 6.2% (66/1059) compared to 3.4% (202/6018) if the fibula, radial or scapula was used (p<0.001). Details relating to osteotomy rate, non-union and fistula rates were evaluated. Iliac crest was most often rehabilitated with implantretained prosthesis (44%, 100/229), compared to 26% (605/2295) (p<0.001) if another flap was used. Changing trends over the study period were not apparent, regarding flap choice or related complications.Although we are able to show some significant differences relating to the type of flap used, it is disappointing to present the underreporting of fundamental outcomes such as the osteotomy rate, non-union and fistula rates. This review demonstrates the need for more comprehensive and consistent outcome reporting, that will allow the comparison of different techniques for similar defects.

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“…9 In patients who may not be fit for extensive surgery involving free tissue transfer due to comorbidities, regional soft tissue flaps such as pedicled pectoralis major or cervicodeltopectoral can be used for reconstruction of L and H defects. In practice, it was found in a study by Deleyiannis et al 23,24 that advanced age (>70 years), moderate or severe comorbidity, and tumor involvement of the base of the tongue were factors that favored use of regional flaps.…”

Section: Type Of Defect and Approach To Reconstructionmentioning

confidence: 99%

Reconstruction of Mandibular Defects

Chim

Salgado

Mardini

et al. 2010

Seminars in Plastic Surgery

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Defects requiring reconstruction in the mandible are commonly encountered and may result from resection of benign or malignant lesions, trauma, or osteoradionecrosis. Mandibular defects can be classified according to location and extent, as well as involvement of mucosa, skin, and tongue. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome, with the fibula flap remaining the gold standard for mandible reconstruction. In this review, we discuss classification and approach to reconstruction of mandibular defects. We also elaborate upon four commonly used free osteocutaneous flaps, inclusive of fibula, iliac crest, scapula, and radial forearm. Finally, we discuss indications and use of osseointegrated implants as well as recent advances in mandibular reconstruction. Continuing advances in mandibular reconstruction have greatly improved functional and aesthetic outcomes for patients. Outcomes from free vascularized bone flaps have proved markedly superior to those obtained from use of nonvascularized options such as reconstruction plates and bone grafts. The free fibula flap continues to remain the gold standard for mandibular reconstruction against which other modalities are compared.The mandible serves several important functions in the head and neck, which can be restored to nearnormality with the use of vascularized bone flaps. It provides a stable platform for the oral cavity and also a structure to which muscles attach. Most importantly, it allows mastication by providing a stable counterpoint to the maxilla and serving as a base for attachment of dentition. It facilitates speech, swallowing, and breathing by maintaining space within the oral cavity and allowing the tongue to function. It also serves an aesthetic function, defining the projection of the lower third of the face. ANATOMY OF THE MANDIBLEThe mandible is a U-shaped bone that articulates with the skull base through two unique temporomandibular joints (TMJs), which allow smooth and coordinated mouth opening. The TMJ is a diarthrodial joint, consisting of two bones articulating in a discontinuous fashion allowing freedom of movement dictated by muscles and limited by ligamentous attachments. The TMJ is also lined on its internal aspect by synovium, which secretes synovial fluid, serving both as a lubricant and a nutrition source for joint structures.

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Prognosis as a determinant of free flap utilization for reconstruction of the lateral mandibular defect

Cited by 17 publications

References 36 publications

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta‐analysis

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta‐analysis

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Reconstruction of Mandibular Defects

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