Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study

Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety.Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection.Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case.Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.

Correction of Temporal Hollowing Deformity Using Serratus Anterior Muscle Flap

Temporal hollowing deformity (THD) is a contour irregularity in the frontotemporal region, which results in facial asymmetry in the frontal view. Here, we present our clinical experience of correction of THD using serratus anterior (SA) muscle and fascia free flaps. Between March 2016 and December 2018, 13 patients presenting with THD were treated with SA free flap. The mean age of the patients was 47.8 years. The patients received craniectomy due to subarachnoid hemorrhage, epidural hematoma, or brain tumor. On average, correction of THD was performed 17 months after cranioplasty. The SA flap size ranged from 5 × 5 cm to 10 × 8 cm . The mean operation time was 107.3 minutes. All of the flaps survived without complications. The mean follow-up duration was 20.3 months. For correction of THD, the SA muscle and fascia flap is among the best candidates to permanently restore aesthetic form and symmetry.

Multiple Free Flap Reconstruction of a Complex Intraoral Defect after Squamous Cell Carcinoma Excision: A Case Report

Background: Squamous cell carcinoma is the most frequent malignant cancer of the oral cavity. Metastasis involvement is one of the most relevant prognostic factors in terms of survival probability. Patients with oral cancers often undergo extensive en bloc resective surgery of the mandible and maxilla, with or without cervical nodal dissection, based on the presence or occult risk of regional metastases. Several factors affect the choice of flap, to recover aesthetics and function. Case Presentation: The case of a 60-year-old man who underwent maxillectomy with neck dissection as well as a reconstruction with a combination of multiple vascularized free flaps is presented. Conclusions: The excellent integration of the free flaps and the total absence of complications led to a high-quality aesthetic and functional performance of the reconstruction obtained through two different flaps. More specifically, the fibular free flap for bone reconstruction allows a two-team approach and maintains an excellent vascularization, even in case of several osteotomies for the maxillary reconstruction as reported. In addition, the use of free radial forearm flap for soft tissue reconstruction permits to obtain long caliber vessels, thus facilitating surgery without repositioning of the patient during surgery and therefore, consequently reducing surgery times.

Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

BackgroundFree tissue transfer encompasses a variety of techniques by which tissue is moved to another region of the body, with anastomosis of the divided artery and vein. Currently, success rates are reported at 91-99% [1], however, little is known regarding predictors for adverse outcomes.We aim at identifying predictors for negative outcomes following free flap surgery; and predict that elderly patients and patients with head and neck free flaps will have inferior outcomes due to comorbidity.MethodsThis is a retrospective case series. All free flap surgeries between 02/2018 to 02/2021 were identified using the electronic operation record system at Flinders Medical Centre. Chi squared hypothesis testing assessed patient factors and implications on outcome. Results67 patients of varying demographics were included in this study. The odds of wound infection was much higher in patients aged older than 65 (OR: 4.1 (95%CI 1.24-13.6, z-score: 2.31, p=0.017)). The odds of unplanned reoperation was also higher in this population (OR: 13.7 (95%CI 1.42-132.9, p=0.0053)). Free flap location was significant in determining whether patients would require a subsequent blood transfusion (p=0.0071). Head and neck patients did not experience a higher rate of adverse events.ConclusionPatients aged 65 and older are more likely to require treatment for infection and more often require reoperation because of flap related issues. Patients with limb free flaps are more likely to require transfusions. Head and neck patients did not have higher complication rates.