Floor plan - 2013 Annual Meeting - American Association for Hand ...

ASRM SCIENTIFIC PAPER PRESENTATIONS:
MISCELLANEOUS
Using Stereolithographic Models to Plan Mandibular Reconstruction for Advanced Oral
Cavity Cancer
Institution where the work was prepared: Fox Chase Cancer Center, Philadelphia, PA, USA
Eric Y. Ro, MD1; John A. Ridge, MD, PhD, FACS2; Neal S. Topham, MD2; (1)Fox Chase Cancer Center/Temple
University, (2)Fox Chase Cancer Center
INTRODUCTION:
Use of the fibula osteocutaneous free flap in mandibular reconstruction has allowed patients to recover essential aspects of mandibular
function, including oral competence, mastication, and aesthetic appearance. To improve the efficiency, accuracy and outcomes of
such procedures, we present our use of stereo lithographic modeling in fifteen patients with oral cancer that require mandibular reconstruction.
This technique is especially beneficial for patients where tumor bulk extends laterally from the mandible.
METHODS:
Fifteen patients underwent computed tomography (CT) scan of the mandible using specific parameters (20 cm FOV, pitch 1.0, 1 mm
slice, 120-280 mA) and the data was sent to ProtoMed (Arvada, CO). A 3-D anatomic epoxy model was returned to the reconstructive
surgeon. A 2.4 mm or 3.0 mm locking reconstruction plate (Synthes, Inc., West Chester, PA) was bent and pre-cut to the patient's model
and then sterilized prior to the procedure. Intra-operatively, the pre-bent titanium plate was used to drill holes needed to secure the
plate to the native mandible prior to performing the osteotomies. The plate was then sterilized and used as a three-dimensional template
to create an accurate neo-mandible using the fibula flap. If tumor extension inhibited plate alignment, holes were drilled after the
osteotomies were performed. In this scenario, accurate alignment was achieved using landmarks on the mandibular model and plate.
RESULTS:
This technique was especially useful with neoplasms that extend laterally from the mandible because the bulk of the lesion prevented
contouring of the titanium reconstruction plate at the time of surgical resection. Alignment of the pre-bent plate eliminated operating
time typically dedicated to plate contouring. There were no complications attributable to this technique. There were no flap failures.
One patient developed a local recurrence.
CONCLUSIONS:
Use of stereo lithographic models in mandibular reconstruction allows for accurate contouring of the plate to the mandible, reduces
operative time, and provides a method to reconstruct patients whose tumors extend laterally to the buccal soft tissues.
Timing of Microsurgical Reconstruction of Lower Extremity: Is It Really Important In Flap
Failure
Institution where the work was prepared: Gulhane Military Medical Academy, Ankara, Turkey
Fatih Zor; Mustafa Sengezer; Murat Turegun; Selcuk ˘sik; Mustafa Nisanci; Muhidtin Eski; Gülhane Military Medical
Academy
Landmine injuries of the lower extremity constitute a challenging problem to the reconstructive surgeon. These injuries create composite
tissue defects which are always contaminated. The transfer of the patient to a well established center generally takes time. All these
factors yield a delay at the definitive treatment of the patient. Here, we want to present patients injured by landmine explosions and
treated at different times and to discuss the effect of timing of the microvascular tissue transfer on success of the procedure. Between
1995-2006, 109 patients were treated by microvascular tissue transfers at Gulhane Military Medical Academy in Department of Plastic
and Reconstructive Surgery. All patients were injured due to landmine explosion and reconstructed with microvascular tissue transfer.
The flap success rate and postoperative complications were evaluated. The average follow-up period was 19 months. Of the 109
patients, 12 were operated between 0-7 days (group I-at the acute period). Forty-two of them were operated at the subacute period
(group II, between 7-14 days) and the remaining 55 were operated at the chronic period (group III, more than 14 days). There was no
flap loss in group I patients. Flap failure rate was 16.7 % and 14.5 % for group II and group III, respectively and the difference was not
significant. No postoperative infection was observed at the acute period. Postoperative infection rate was 16.7 % and 7.3 % at subacute
and chronic period respectively, and the difference was statistically significant. Microvascular reconstruction of the lower extremity
at the acute period is preferred but landmine injuries are not always possible to operate at the acute period. Posttraumatic vessel
disease is known to be the most important reason of the flap failure. Although, Godina et al. advocates that the acute period is the first
2 days, we agree with Byrd et al as it is the first 7 days. So we think that the critical period for the microvascular surgery should be considered
as the first 7 days. When the surgery is performed according to microvascular principles subacute period does not differs from
chronic period when the flap failure is concerned. Subacute period is associated with a higher infection rate.
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