Two stage reconstruction with revascularized grafts after resection of retromolar and oropharyngeal carcinoma

Kermer, Christian; Ziya-Ghazvini, Farzad; Poeschl, Paul W.; Klug, Clemens

doi:10.1016/j.ijom.2003.10.022

Cited by 16 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In current clinical practice, definitive mandibular resection can be performed in two stages to treat underlying infection of the wound, to prepare suitable free flaps, or to stimulate a regenerative environment for the definitive reconstruction by promoting healthy soft tissue development over the defect site (8)(9)(10). To this effect, space maintainers have been successfully used to aid two-stage mandibular repair in human cases (10)(11)(12).…”

mentioning

confidence: 99%

Biomaterials-aided mandibular reconstruction using in vivo bioreactors

Tatara

Koons

Watson

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Large mandibular defects are clinically challenging to reconstruct due to the complex anatomy of the jaw and the limited availability of appropriate tissue for repair. We envision leveraging current advances in fabrication and biomaterials to create implantable devices that generate bone within the patients themselves suitable for their own specific anatomical pathology. The in vivo bioreactor strategy facilitates the generation of large autologous vascularized bony tissue of customized geometry without the addition of exogenous growth factors or cells. To translate this technology, we investigated its success in reconstructing a mandibular defect of physiologically relevant size in sheep. We fabricated and implanted 3D-printed in vivo bioreactors against rib periosteum and utilized biomaterial-based space maintenance to preserve the native anatomical mandibular structure in the defect site before reconstruction. Nine weeks after bioreactor implantation, the ovine mandibles were repaired with the autologous bony tissue generated from the in vivo bioreactors. We evaluated tissues generated in bioreactors by radiographic, histological, mechanical, and biomolecular assays and repaired mandibles by radiographic and histological assays. Biomaterial-aided mandibular reconstruction was successful in a large superior marginal defect in five of six (83%) sheep. Given that these studies utilized clinically available biomaterials, such as bone cement and ceramic particles, this strategy is designed for rapid human translation to improve outcomes in patients with large mandibular defects.

show abstract

mentioning

confidence: 99%

Biomaterials-aided mandibular reconstruction using in vivo bioreactors

Tatara

Koons

Watson

et al. 2019

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

show abstract

“…10 While the skin paddle of the iliac crest can be incorporated into the second stage of this reconstruction, this skin transfer is not as accommodating to the functional needs of the oral cavity as the primary soft tissue flap used in the first stage of this reconstruction. 11 An important aspect of staged reconstruction is the allotment of time between stages. This time allows the physician to assess the success of the initial procedure and to alter the plan for the secondary procedure based on any outstanding reconstructive needs.…”

Section: Discussionmentioning

confidence: 99%

“…The natural shape and robust bone stock of the iliac crest makes it suitable for contouring to a variety of mandibular defects and permits reliable implant supported dental rehabilitation. 10,11 A large amount of soft tissue can be harvested as well, depending on the remaining defect. In addition, the large-caliber, reliable donor vessels are favorable, especially in the setting of multiple failures.…”

Section: Discussionmentioning

confidence: 99%

A staged approach to oromandibular reconstruction using the iliac crest free flap in the setting of bilateral failed fibula free flaps

et al. 2023

View full text Add to dashboard Cite

Background While a single‐stage free‐flap reconstruction is the preferred approach for oromandibular defects, a multistaged approach may be necessary in rare cases. These patients can still be effectively restored with functional and aesthetic improvements. Methods We report two cases with a history of bilateral failed fibula free flaps. We detail the multistaged reconstruction to repair these complex defects and discuss the considerations when planning such procedures. Results Both patients successfully underwent a staged reconstruction with an iliac crest osteocutaneous flap following either a rectus abdominis or pectoralis major myocutaneous flap. Conclusion Oromandibular reconstruction is an expected outcome in the contemporary management of oral cavity cancer and osteoradionecrosis. However, complications do occur and can be devastating. In cases of bilateral failed fibula free flaps, a staged approach is a favorable option. Moreover, the iliac crest provides an important reconstructive option with the documented potential for implant born dental rehabilitation.

show abstract

“…The 11-week preparation and in vitro culture period is compatible with the timeline of two-stage maxillofacial reconstruction, which is widely used for many clinical indications, from cancer surgery to traumatic injury. The time between the first operation (damaged tissue resection and space maintainer placement) and the second operation (graft reconstruction) usually spans several months, allowing ample time to prepare and culture patient-tailored living autologous grafts (58,59). The time limiting step in our current protocol is the expansion of cells to usable numbers.…”

Section: Discussionmentioning

confidence: 99%

Tissue engineered autologous cartilage-bone grafts for temporomandibular joint regeneration

Chen

Kennedy

et al. 2020

Sci. Transl. Med.

View full text Add to dashboard Cite

Joint disorders can be detrimental to quality of life. There is an unmet need for precise functional reconstruction of native-like cartilage and bone tissues in the craniofacial space and particularly for the temporomandibular joint (TMJ). Current surgical methods suffer from lack of precision and comorbidities and frequently involve multiple operations. Studies have sought to improve craniofacial bone grafts without addressing the cartilage, which is essential to TMJ function. For the human-sized TMJ in the Yucatan minipig model, we engineered autologous, biologically, and anatomically matched cartilage-bone grafts for repairing the ramus-condyle unit (RCU), a geometrically intricate structure subjected to complex loading forces. Using image-guided micromilling, anatomically precise scaffolds were created from decellularized bone matrix and infused with autologous adipose-derived chondrogenic and osteogenic progenitor cells. The resulting constructs were cultured in a dual perfusion bioreactor for 5 weeks before implantation. Six months after implantation, the bioengineered RCUs maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a greater extent than either autologous bone-only engineered grafts or acellular scaffolds. Tracking of implanted cells and parallel bioreactor studies enabled additional insights into the progression of cartilage and bone regeneration. This study demonstrates the feasibility of TMJ regeneration using anatomically precise, autologous, living cartilage-bone grafts for functional, personalized total joint replacement. Inclusion of the adjacent tissues such as soft connective tissues and the TMJ disc could further extend the functional integration of engineered RCUs with the host.

show abstract

Two stage reconstruction with revascularized grafts after resection of retromolar and oropharyngeal carcinoma

Cited by 16 publications

References 16 publications

Biomaterials-aided mandibular reconstruction using in vivo bioreactors

Biomaterials-aided mandibular reconstruction using in vivo bioreactors

A staged approach to oromandibular reconstruction using the iliac crest free flap in the setting of bilateral failed fibula free flaps

Tissue engineered autologous cartilage-bone grafts for temporomandibular joint regeneration

Contact Info

Product

Resources

About