Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction

Abstract

Purpose:The purpose of this study was to present the outcome and discuss the feasibility of rib composite flap with intercostal nerve and internal thoracic vessels for reconstructing mandibular defect.Methods:Rib composite flaps have been used in 82 patients for reconstructing benign tumor-caused large mandibular defects: 66 of the 82 patients were reconstructed using rib composite flap with intercostal nerve and internal thoracic vessels, whereas the other 16 patients were reconstructed using rib composite flap with internal thoracic vessels, without intercostal nerve. After operation, clinical observation, imageological examination, and sensory detection were used to evaluate the effect of reconstruction.Results:All rib composite flaps with intercostal nerve and internal thoracic vessels were successfully harvested and transplanted. Both immediate and long-term examination showed good appearance reconstruction. All followed-up patients conveyed good satisfaction degree with function and appearance reconstruction. Postoperative panoramic x-ray examination showed new bone formation between the transplanted rib and mandibular stump. Good recoveries of mandibular nerve sensory were observed when followed up after reconstruction surgery.Conclusions:Rib composite flap with intercostal nerve and internal thoracic vessels could be a promising method for reconstruction of mandibular defects.

Novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap

“…Zhang et al 37 introduced an innervated rib composite flap to reconstruct the IAN using the intercostal nerve, showing satisfactory recovery of lower lip sensation using neurometer and current perception threshold, with minimal donor site sensory affection due to overlapping cutaneous distribution of the intercostal nerve. However, due to the limited rib length, this method was not suitable for large mandible defects, with thin and fragile rib cortex not suitable for dental implantation.…”

Microsurgical reconstruction of the facial skeleton in the treatment of malignant tumors of the head and neck

“…Реберный трансплантат может быть сформирован с включением зубчатой мышцы или широчайшей мышцы спины и имеет длинную, надежную сосудистую ножку. Этот трансплантат подходит только для восстановления небольших по протяженности дефектов нижней челюсти (до 11 см); кортикал реберного фрагмента более тонкий и хрупкий, чем, например, у малоберцового и подвздошного лоскутов, что делает его менее подходящим для установки зубных имплантатов [31].…”

Application of a Bioactive/Bioresorbable Three-Dimensional Porous Uncalcined and Unsintered Hydroxyapatite/Poly-d/l-lactide Composite with Human Mesenchymal Stem Cells for Bone Regeneration in Maxillofacial Surgery: A Pilot Animal Study

“…Many patients suffer from mandibular defects due to benign or malignant tumors, trauma, and dysplastic pathologies [ 1 ], which can damage chewing function, mental health, and facial esthetics in patients. Therefore, the ability to perform high quality three-dimensional (3D) mandibular reconstruction is of critical importance [ 2 ].…”