Alessandro Bolzoni

Stair Ascent and Descent in Assessing Donor-Site Morbidity Following Osteocutaneous Free Fibula Transfer: A Preliminary Study

PURPOSE The aim of this study was to investigate gait kinematic parameters during stair ascent and descent after fibula free flap removal for facial reconstruction. MATERIALS AND METHODS Eight patients who underwent facial reconstruction with fibula free flap removal ascended and descended 3 standard steps. Their movements were recorded by a motion analyzer; gait kinematic parameters were obtained and compared with those calculated in 8 control subjects. RESULTS Stride time, percentage of swing, and support phases did not differ among healthy and operated limbs and control subjects (Kruskal-Wallis, P > .05). No significant differences were found for hip and knee movements, pelvis rotation and tilt, and body center of mass displacements. During stair descent, the patients had significantly larger pelvis inclinations than the control subjects (P < .05). CONCLUSIONS No functional limitations during stair performance were found. The only significant difference could indicate a minor control of the pelvis and should be used to define specific rehabilitative interventions.

Evaluation of three-dimensional mandibular movements after reconstruction with free fibula flap.

SUMMARY Seven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation.

Fibula free flap pedicle ossification: Experience of two centres and a review of the literature

PURPOSE The osteogenic potential of vascularized periosteum has been described in a few cases in the literature, and many different factors have been pointed out as plausible. Our aim was to review the literature in order to give a complete overview of this topic and to report on our clinical experience. PATIENTS & METHODS Our experience includes three patients who underwent maxillectomy and FFF reconstruction. A progressive reduction in mouth opening was noticed in the months after surgery, and CT scans showed calcified tissue around the pedicle. Surgical revisions were performed. No recurrences were noticed. A full systematic literature review was conducted, including studies published on or before September 2016. RESULTS Clinically, free flap pedicle ossification is presented as trismus, hard swelling, and severe pain during movements, although the diagnosis is scarce and often fortuitous. From January 2010 to January 2016 we performed 68 FFF reconstructions, and the incidence of FFF pedicle ossification in our experience was 4.4%. CONCLUSION Ossification of FFF pedicle is uncommon, but when it occurs, it has dramatic clinical consequences. Follow-up CT scan can be useful in diagnosis. In our experience, surgery should be performed only when the patient is symptomatic.