Kazuki Hasegawa

Oral and maxillofacial reconstruction using the free rectus abdominis myocutaneous flap: Various modifications for reconstruction sites

The rectus abdominis myocutaneous flap consists of the skin paddle, anterior rectus sheath, rectus muscle and deep inferior epigastric artery and veins. Of these four components, the skin paddle, rectus sheath and rectus muscle could all be adjusted appropriately for reconstruction sites. Only one or two large perforators in the paraumbilical region could easily supply the large abdominal wall. The bulkiness of the rectus abdominis flap is reduced by removal of subcutaneous fat and rectus muscle. These possibilities can provide many modification of the flap for various reconstruction sites. 16 cases were reconstructed primarily and secondarily using this flap after oral and maxillofacial tumour ablation. The results of these cases indicated a very favourable and reliable vascularity. The rectus abdominis myocutaneous flap was considered to be one of the most suitable flaps for oral and maxillofacial reconstruction. Various modifications for different reconstruction sites are mainly discussed.

Complications and Outcome of Free Flap Transfers for Oral and Maxillofacial Reconstruction: Analysis of 213 Cases

Abstract Microvascular free flap transfers have become a preferred reconstructive technique; however, rare complications may still prove devastating. This study reviewed 213 consecutive freetissue transfers in order to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the oral and maxillofacial region. In most cases, reconstruction was undertaken after resection of a malignant tumor. The flap donor sites were the radial forearm (n=111), rectus abdominis (n=88), scapula (n=13), and latissimus dorsi (n=1). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. The overall flap success rate was 99%. There were 7 cases of postoperative vascular thrombosis (6 venous and 1 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re-exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re-exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.

A case of bilateral chylothorax after radical neck dissection

Bilateral chylothorax is a rare complication of radical neck dissection. We experienced a case of bilateral chylothorax after neck dissection on the left side. A 54-year-old man with pain in the mandibular gingiva was referred to our hospital from a dental clinic on 28th January 200X, and was diagnosed with squamous cell carcinoma of the left oral floor. Left radical neck dissection, right supraomohyoid neck dissection, marginal dissection of the left mandible, tumor resection of the left tongue and left oral floor, rectus abdominal free flap reconstruction, and tracheotomy were performed after preoperative chemoradiotherapy. On day 3 postoperatively, his oxygen saturation was remarkably decreased. Chest X-ray revealed bilateral pleural effusion. Pulmonary specialists were consulted and thoracic cavity drainage of the left side was performed. Biochemical analysis of the milky white effusion indicated bilateral chylothorax. On day 6 postoperatively, pleural effusion of the right thoracic cavity was increased, therefore a right thoracic drainage tube was inserted. A central venous catheter had been installed and total parenteral nutrition was initiated. Drainage from both sides of the chest decreased over the following week. As the volume of drainage fluid did not increase, the thoracic drainage tubes were removed 21 days after the operation. On day 22 postoperatively, medium-chain triglyceride diet was started. Over the five-year follow-up, the patient remains free from chylothorax.

Various types of free flaps based on the subscapular vascular system for oral and maxillofacial reconstruction

B t h d u d i s b a a p t i c m u M i m e m F a a t t raft materials. In this study, long period bservations over ten years after bone rafting were respectively evaluated. Ten f 211 patients had installed implant at iigata Hospital, School of Life Dentistry t Niigata, The Nippon Dental University ver a 16-year period from 1989 through 005. There were four men and six females ged 14 to 67 years (average, 48.3 years). one grafts were performed in five (50%) alignant tumour, three (30%) absorbed lveolar ridge and two (20%) traumatic njuries. Material of bone grafts were all utogenous bones of iliac bone block or CBMs—three scapular or fibular revasularised bone grafts, and two mandibular hin bone or buccal site of wisdom tooth. otal of 62 implants were placed in the rafted bone. 58 implants (93.5%) were uccessful, but four (6.5%) were lost. We eed additional careful observation even hough ten years has passed.