Evolution of midface microvascular reconstruction: three decades of experience from a single institution
Abstract
Purpose Midface reconstruction poses a complex set of challenges for reconstructive surgeons. The optimal midface reconstruction must possess a durable underlying bone construct capable of integrating dental implants. Facial contour is restored by the overlying microvascular soft tissue reconstruction with reestablishment of the oral cavity. A plethora of microvascular flaps used in clinical practice have been described including those harvested from the iliac crest, scapula, fibula, forearm and back (latissimus dorsi). The objective was to share our experiences with each of these treatment options that have continued to evolve over time for the benefit of patients. Methods Our institution has over three decades of experience in reconstructing complex midface defects and this article summarizes midface reconstruction from an evolutionary perspective (for type II, III and IV defect; Browns classification, Supplementary Table I). We broadly divide this into (i) flaps supplied by the subscapular system (ii) autologous reconstruction with titanium mesh and (iii) fibula microvascular flaps using 3D planning. Results The advantages and disadvantages for each approach are discussed (Supplementary Table II). Conclusion In the future, it is expected that 3D planning coupled with rapid prototyping, intraoperative navigation and CT imaging will become standard procedural practice.Citation
Vedran U, Kavit A, Igor B, Damir K. Evolution of midface microvascular reconstruction: three decades of experience from a single institution. European Archives of Oto-Rhino-Laryngology. Springer Science and Business Media LLC; 2022.Journal
European Archives of Oto-Rhino-LaryngologyDOI
10.1007/s00405-022-07321-xPubMed ID
35316380Additional Links
https://dx.doi.org/10.1007/s00405-022-07321-xType
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1007/s00405-022-07321-x
Scopus Count
Collections
Related articles
- Microsurgical reconstruction of the maxilla: Algorithm and concepts.
- Authors: Costa H, Zenha H, Sequeira H, Coelho G, Gomes N, Pinto C, Martins J, Santos D, Andresen C
- Issue date: 2015 May
- Three-dimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap.
- Authors: He Y, Zhu HG, Zhang ZY, He J, Sader R
- Issue date: 2009 Dec
- Combination of microvascular medial femoral condyle and iliac crest flap for hemi-midface reconstruction.
- Authors: Brandtner C, Hachleitner J, Buerger H, Gaggl A
- Issue date: 2015 Jun
- Scapula free flap for complex maxillofacial reconstruction.
- Authors: Valentini V, Gennaro P, Torroni A, Longo G, Aboh IV, Cassoni A, Battisti A, Anelli A
- Issue date: 2009 Jul
- Reconstruction of the midface and maxilla.
- Authors: O'Connell DA, Futran ND
- Issue date: 2010 Aug