Pedicle Orientation in Free-Flap Microvascular Maxillofacial Reconstruction.

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Pedicle Orientation in Free-Flap Microvascular Maxillofacial Reconstruction.

J Oral Maxillofac Surg. 2016 Dec 10;:

Authors: Cummins DM, Kim B, Kaleem A, Zaid W

Abstract
Oncologic and traumatic defects of the maxilla can pose a challenge to patients, reconstructive surgeons, and maxillofacial prosthodontists in an attempt to provide satisfactory treatment. Oral-nasal and oral-antral fistulas are frequently treated with soft tissue flaps, osteocutaneous flaps, or a maxillofacial obturator. Often, surgical reconstruction is preferred for patient quality of life and definitive restoration. Surgical reconstruction also avoids the difficulties encountered with fabricating an obturator in an irradiated field with the often-resultant microstomia. Reconstruction of a maxillectomy defect with an osteocutaneous flap affords a permanent structural reconstruction with the ability to simultaneously provide functional dental rehabilitation. The free fibula microvascular osteocutaneous flap has proved the workhorse of these maxillary and mandibular reconstructions. The success of microvascular reconstruction often hinges on flap viability in the immediate postoperative period. With most flap failures attributed to vascular compromise resulting from clot formation and venous congestion, attention to antiplatelet and anticoagulant agents and passive, uncompressed, and nontortuous pedicle positioning demands surgical attention and postoperative monitoring. Although the use of the free fibula flap in maxillary reconstruction is a well-described and predictable procedure, the specifics of the flap inset with respect to pedicle positioning and technique within the maxilla and neck have not been clearly detailed in the available studies. In the present technique note, we have provided our surgical description for pedicle positioning and anatomic alterations in an attempt to improve microvascular anastomosis flap success.

PMID: 28039007 [PubMed - as supplied by publisher]

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