Computer-assisted surgery for reconstruction of complex mandibular defects using osteomyocutaneous microvascular fibular free flaps: Use of a skin paddle-outlining guide for soft-tissue reconstruction. A technical report
| Autor: | Vincenzo Maiolo, Riccardo Cipriani, Salvatore Battaglia, Francesco Ricotta, Emanuela Marcelli, Laura Cercenelli, Claudio Marchetti, Achille Tarsitano, Federico Contedini, Barbara Bortolani, Gabriella Savastio |
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| Přispěvatelé: | Battaglia, Salvatore, Ricotta, Francesco, Maiolo, Vincenzo, Savastio, Gabriella, Contedini, Federico, Cipriani, Riccardo, Bortolani, Barbara, Cercenelli, Laura, Marcelli, Emanuela, Marchetti, Claudio, Tarsitano, Achille |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Reconstructive surgery medicine.medical_specialty Computer-assisted surgery Adolescent medicine.medical_treatment Free flap Mandible Free Tissue Flaps CAD/CAM 03 medical and health sciences Young Adult 0302 clinical medicine Imaging Three-Dimensional Clinical Protocols Soft tissue reconstruction medicine Virtual planning Humans Mandibular reconstruction Child Fibular free flap Aged Skin Aged 80 and over business.industry Soft tissue 030206 dentistry Middle Aged Skin paddle Otorhinolaryngology Surgery Computer-Assisted 030220 oncology & carcinogenesis Computer-Aided Design Surgery Female Oral Surgery Computed topographic angiography Mandibular Reconstruction Nuclear medicine business Tomography X-Ray Computed |
| Zdroj: | Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 47(2) |
| ISSN: | 1878-4119 |
| Popis: | Introduction We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery. Technical report We applied our protocol to 42 consecutive patients needing mandibular composite reconstruction. All patients were preoperatively studied with a CTA scan to evaluate the fibular pattern of vascularization and the perforator vessels three-dimensional path and position. Computer assisted surgery (CAS) was performed: a skin paddle outlining guide (SPOG) was designed to reproduce the shape and area of the planned soft tissue resection. CTA measurements and in vivo findings were compared. After performing the CTA, we classified the viable perforators in High Perforators, Medium Perforators and Low Perforators. The average diameter of the perforator vessels was 3 mm. The average difference between the measurements performed on the CTA and the intra-operative measures was 1, 4 mm. The SPOG was based on calf proximal and distal diameters. The anatomical fitting of the guide was obtained thanks to two customized flanges that embrace circumferentially the proximal and distal portions of the leg. The SPOG encompassed appropriate skin/leg regions, allowing the surgeon to localise the required perforator vessel. Conclusions CTA protocol appears to be a valuable approach to asses and virtually simulate composite mandibular reconstructions. The SPOG seems to be a valuable tool to reproduce intra-operatively the planned soft tissue area to be reconstructed. |
| Databáze: | OpenAIRE |
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