scholarly journals The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success?

2017 ◽  
Vol 02 (02) ◽  
pp. e103-e110 ◽  
Author(s):  
Andreas Kolk ◽  
S. Haidari ◽  
K.-D. Wolff ◽  
A. Fichter ◽  
V. Kehl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Graft Loss ◽  
Tumor Resection ◽  
Vascular Occlusion ◽  
Mandibular Reconstruction ◽  
Skin Paddle ◽  
Non Union ◽  
Osteosynthesis Material ◽  
Optimum Selection ◽  
Fibular Flap

Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction. Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study. Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001). Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.

scholarly journals Mandibular Reconstruction with Free Fibula Flap: Experience at Hayatabad Medical Complex, Peshawar

2019 ◽  
Vol 8 (4) ◽  
pp. 198-202
Author(s):  
Syed Asif Shah ◽  
Irfan Ullah ◽  
Muhammad Bilal ◽  
Mohammad Hamayun Shinwari ◽  
Adeeba Ahmad ◽  
...  
Keyword(s):  
Success Rate ◽  
Donor Site ◽  
Graft Loss ◽  
Tumor Resection ◽  
Mandibular Reconstruction ◽  
Diabetic Patients ◽  
Free Fibula Flap ◽  
Skin Paddle ◽  
Fibula Flap ◽  
Free Fibula

Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.

Reconstruction of Mandible with Free Fibula Flap:Report of Three Cases

2021 ◽  
Vol 13 ◽  
pp. 307-312
Author(s):  
Madhusudhana Reddy Dasara ◽  
Somashekar L Samagandi ◽  
Yadavalli Guruprasad ◽  
Manjunath Reddy B ◽  
Basavaraj Katakol
Keyword(s):  
Reconstructive Surgery ◽  
Primary Source ◽  
Mandibular Reconstruction ◽  
Skin Paddle ◽  
Free Fibular Flap ◽  
Free Fibula ◽  
Fibular Flap ◽  
The Ideal

Mandibular reconstructive surgery has changed in the recent times with the introduction of advanced techniques. Mandibular reconstruction a challenge for the reconstructive surgeons, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes using vascularised fibular flap in various mandibular pathologies. The ideal reconstruction should restore the anatomic contour, speech, mastication and aesthetics. The free vascularised fibular flap is the primary source of bone for reconstruction of large segmental mandibular defects due to its rich vascularity. We present three cases of segmental mandibular defects reconstructed primarily with vascularised free fibular flap without skin paddle which were followed up for two years.

Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

2001 ◽  
Vol 40 (02) ◽  
pp. 51-58 ◽  
Author(s):  
H. Schliephake ◽  
van den Hoff ◽  
W. H. Knapp ◽  
G. Berding
Keyword(s):  
Blood Flow ◽  
Regional Blood Flow ◽  
Venous Blood ◽  
Mandibular Reconstruction ◽  
Reference Region ◽  
Osteoblastic Activity ◽  
Non Union ◽  
Range Of Values ◽  
Measured Input

Summary Aim: Determination of the range of regional blood flow and fluoride influx during normal incorporation of revascularized fibula grafts used for mandibular reconstruction. Evaluation, if healing complications are preceded by typical deviations of these parameters from the normal range. Assessment of the potential influence of using “scaled population-derived” instead of “individually measured” input functions in quantitative analysis. Methods: Dynamic F-l 8-PET images and arterialized venous blood samples were obtained in 11 patients early and late after surgery. Based on kinetic modeling regional blood flow (K1) and fluoride influx (Kmlf) were determined. Results: In uncomplicated cases, early postoperative graft K1 - but not Kmlf -exceeded that of vertebrae as reference region. Kmn values obtained in graft necrosis (n = 2) were below the ranges of values observed in uncomplicated healing (0.01 13-0.0745 ml/min/ml) as well as that of the reference region (0.0154-0.0748). Knf values in mobile non-union were in the lower range - and those in rigid non-union in the upper range of values obtained in stable union (0.021 1-0.0694). If scaled population-derived instead of measured input functions were used for quantification, mean deviations of 23 ± 17% in K1 and 12 ± 16% in Kmlf were observed. Conclusions: Normal healing of predominantly cortical bone transplants is characterized by relatively low osteoblastic activity together with increased perfusion. It may be anticipated that transplant necrosis can be identified by showing markedly reduced F− influx. In case that measured input functions are not available, quantification with scaled population-derived input functions is appropriate if expected differences in quantitative parameters exceed 70%.

scholarly journals Risk Factors for Non-union in First MTPJ Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Andrew Molloy ◽  
Clifford Butcher ◽  
Lyndon Mason
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Univariate Analysis ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved

The vascularized fibular flap for mandibular reconstruction

1991 ◽  
Vol 19 (3) ◽  
pp. 113-118 ◽  
Author(s):  
Torstein Lyberg ◽  
Olav Anders Olstad
Keyword(s):  
Mandibular Reconstruction ◽  
Fibular Flap

Multiple Risk Factors Before Pediatric Cardiac Transplantation Are Associated With Increased Graft Loss

2011 ◽  
Vol 33 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Scott R. Auerbach ◽  
Marc E. Richmond ◽  
Jonathan M. Chen ◽  
Ralph S. Mosca ◽  
Jan M. Quaegebeur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Transplantation ◽  
Graft Loss ◽  
Multiple Risk Factors ◽  
Multiple Risk

scholarly journals Risk factors for wound-related reoperations in patients with metastatic spine tumor

2018 ◽  
Vol 28 (6) ◽  
pp. 663-668 ◽  
Author(s):  
Hannah M. Carl ◽  
A. Karim Ahmed ◽  
Nancy Abu-Bonsrah ◽  
Rafael De la Garza Ramos ◽  
Eric W. Sankey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Multivariate Model ◽  
Wound Complications ◽  
Karnofsky Performance Scale ◽  
Thromboembolic Events ◽  
Spine Tumor ◽  
Wound Breakdown ◽  
Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

Enhancement of Bone Implants by Substituting Nitinol for Titanium (Ti-6Al-4V): A Modeling Comparison

2014 ◽  
Author(s):  
Narges Shayesteh Moghaddam ◽  
Mohammad Elahinia ◽  
Michael Miller ◽  
David Dean
Keyword(s):  
Tumor Resection ◽  
Stress Shielding ◽  
High Strength ◽  
Standard Of Care ◽  
Mandibular Reconstruction ◽  
Bone Plate ◽  
Segmental Defect ◽  
Stress Strain ◽  
Element Analysis ◽  
Grade 5

Mandibular segmental defect reconstruction is most often necessitated by tumor resection, trauma, infection, or osteoradionecrosis. The standard of care treatment for mandibular segmental defect repair involves using metallic plates to immobilize fibula grafts, which replace the resected portion of mandible. Surgical grade 5 titanium (Ti-6Al-4V) is commonly used to fabricate the fixture plate due to its low density, high strength, and high biocompatibility. One of the potential problems with mandibular reconstruction is stress shielding caused by a stiffness mismatch between the Titanium fixation plate and the remaining mandible bone and the bone grafts. A highly stiff fixture carries a large portion of the load (e.g., muscle loading and bite force), therefore the surrounding mandible would undergo reduced stress. As a result the area receiving less strain would remodel and may undergo significant resorption. This process may continue until the implant fails. To avoid stress shielding it is ideal to use fixtures with stiffness similar to that of the surrounding bone. Although Ti-6Al-4V has a lower stiffness (110 GPa) than other common materials (e.g., stainless steel, tantalum), it is still much stiffer than the cancellous (1.5–4.5 GPa) and cortical portions of the mandible (17.6–31.2 GPa). As a solution, we offer a nitinol in order to reduce stiffness of the fixation hardware to the level of mandible. To this end, we performed a finite element analysis to look at strain distribution in a human mandible in three different cases: I) healthy mandible, II) resected mandible treated with a Ti-6Al-4V bone plate, III) resected mandible treated with a nitinol bone plate. In order to predict the implant’s success, it is useful to simulate the stress-strain trajectories through the treated mandible. This work covers a modeling approach to confirm superiority of nitinol for mandibular reconstruction. Our results show that the stress-strain trajectories of the mandibular reconstruction using nitinol fixation is closer to normal than if grade 5 surgical titanium fixation is used.

Predictors of tumor progression among children with gangliogliomas

2009 ◽  
Vol 3 (6) ◽  
pp. 461-466 ◽  
Author(s):  
Mostafa El Khashab ◽  
Lynn Gargan ◽  
Linda Margraf ◽  
Korgun Koral ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tumor Progression ◽  
Cox Regression ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Initial Presentation ◽  
Subtotal Resection ◽  
Low Grade ◽  
Cox Regression Analysis ◽  
Presenting Symptoms

Object Few reports describe the outcome and prognostic factors for children with gangliogliomas. The objective of this report was to describe the progression-free survival (PFS) for children with low-grade gangliogliomas and identify risk factors for tumor progression. Methods A retrospective study was performed in children with low-grade gangliogliomas who were evaluated and treated in the neuro-oncology department between 1986 and 2006 to determine risk factors for subsequent tumor progression. Results A total of 38 children with newly diagnosed gangliogliomas were included in this report. Thirty-four children were treated with surgery alone, 3 with subtotal resection and radiation therapy, and 1 with subtotal resection and chemotherapy. The follow-up ranged from 4 months to 15.8 years (mean 5.7 ± 4.2 years [± SD]). Seven children have experienced tumor progression, and 1 child died after his tumor subsequently underwent malignant transformation. The 5-year PFS was calculated to be 81.2% using Kaplan-Meier survival analysis. Initial presentation with seizures (p = 0.004), tumor location in the cerebral hemisphere (p = 0.020), and complete tumor resection (p = 0.035) were associated with prolonged PFS. Further analysis of the above significant variables by a Cox regression model identified initial presentation with seizures as being associated with prolonged PFS (p = 0.028). Conclusions The PFS and overall survival of children with gangliogliomas are good. Tumors located in the cerebral hemispheres, the achievement of total resection, and seizures at presentation were associated with prolonged PFS. Cox regression analysis identified presenting symptoms including seizures as significant predictive factors of PFS. Prospective studies with larger numbers of children are needed to define the significant factors of tumor progression.

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