Oral Rehabilitation of Oncology Patients With Microvascular Free Flaps With a Follow-Up of 2 to 6 Years

BACKGROUND: Reconstruction with free flaps after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate retrospectively oral rehabilitation with microvascular free flaps and dental implants for maxillofacial reconstruction in oncologic patients with a minimum follow-up of 2 years after implant insertions.METHODS: The study consisted of 17 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with microvascular free flaps (free fibular flap, antero-lateral thigh flap, or radial forearm flap). Implants were inserted on the average 30.2±15.5 months after reconstructive operations. A total of 74 implants were inserted. Mean follow up after maxillo-facial surgery was 6.16 years (mean 73.93±14.48 months). Mean follow up after implant insertions was 3.61 years (mean 43.50±12.96). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications.RESULTS: There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. 1 implant was lost in a female patient 15 months after placement. Overall implant survival rate was 97.5%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type.CONCLUSION: According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes.

Consistent Value of Two-Stage Pedicle Flaps in the Age of Microsurgical Maxillofacial Reconstruction

Introduction Up to the second half of the twentieth century, pedicled flaps marked the gold standard in reconstructive surgery. Followed by the introduction of microsurgical techniques, these flaps were increasingly abandoned. We conducted a retrospective study to determine the value of two-stage pedicle flaps in modern maxillofacial reconstruction. Material & Methods A chart review from October 2017 to November 2020 was performed to identify patients who were treated by a two-stage pedicle flap in our Department of Oral and Maxillofacial Surgery. Results A total of 31 patients, 17 female and 14 males received 36 two-stage pedicle flaps. All patients were in noticeably impaired health condition with a majority of ASA-score 3. The defect location mainly contained extraoral resections (58.3%). A variety of flaps were harvested consisting of buccal flaps, Abbe flaps, forehead flaps, deltopectoral flaps, nasolabial flaps, and a tubed flap. Discussion The study outlines two indications for the use of two-stage pedicle flaps. Firstly, as a back-up strategy in heavily pre-treated wound beds and secondly in an almost contrarily indication as a first-choice reconstructive option of the facial skin in esthetic demanding cases. Conclusion The timesaving and straight forward surgical approach as well as their low postsurgical complications and strong long-time success rates secure the two-stage pedicle flap a justified niche role in times of microsurgical maxillofacial reconstruction.