Tags

Type your tag names separated by a space and hit enter

Osteomyocutaneous fibular flap harvesting: Computer-assisted planning of perforator vessels using Computed Tomographic Angiography scan and cutting guide.
J Craniomaxillofac Surg 2017; 45(10):1681-1686JC

Abstract

INTRODUCTION

Mandibular reconstruction performed after virtual planning has become more common during recent years. The gold standard for extensive mandibular reconstruction is of course a fibular free flap. In designing an osteomyocutaneous fibula flap, poor planning, aberrant anatomy and/or inadequate perforator vessels are the most frequent causes of complications and may force the surgeon to modify the flap design, explore the contralateral leg or harvest an additional microvascular flap. The goal of our study was to pre-operatively evaluate the vascular anatomy of the fibula and localize the cutaneous perforator vessels, so to create the fibular cutting guide based on the position of the cutaneous perforator and safely harvest the reconstructive flap.

MATERIALS AND METHODS

Twenty consecutive patients who were candidates for mandibular reconstruction using a fibular microvascular free flap were enrolled in this study between January 2016 and August 2016. The patients were preoperatively assessed with a Computed Tomographic scan of head and neck and with a Computed Tomographic Angiography (CTA) scan of the lower limbs to evaluate the vascular anatomy of the fibula. Virtual planning was carried out for all patients. The fibular cutting guide was based on the position of the perforator cutaneous vessels, which were used to harvest the cutaneous part of the flap. Preoperative CT measurements were performed in order to identify the cutaneous perforators on the patients' skin. Intraoperative checking was performed to evaluate the accuracy of the perforators' position and the reproducibility of the virtual planning.

RESULTS

In 5 patients out of 20 (25%), anatomical anomalies were discovered, without clinical evidence. The perforator vessels were localized in all patients. The average difference between the CTA and the intraoperative perforator localization was 1 mm (range 0-2 mm). Fibular cutting guide was positioned and fitted the anatomy of the patients in all treated patients. This allowed us to perform the planned segmentation of the fibula, obtaining the correct number of segments. In all cases, flap insetting was carried out and skin paddle was positioned as preoperatively planned. Neither donor site complications nor flap complications occurred.

CONCLUSIONS

Preoperative evaluation of the legs using CTA, in patients who undergo an osteomyocutaneous fibular free flap for mandibular reconstruction, is a valuable approach to reduce altered-anatomy related complications and to improve the accuracy and outcomes of the reconstruction, especially in reconstructions of complex defects. In these cases, a soft tissue-based cutting guide can be planned based on the perforator vessels of the skin paddle, minimizing the harvesting risks of vascular lesions. Further studies and longer follow-ups are needed to evaluate the long-term outcomes and advantages of this procedure.

Authors+Show Affiliations

Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.Radiology Department (Head: Prof. Maurizio Zompatori), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy.Radiology Department (Head: Prof. Maurizio Zompatori), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy.Radiology Department (Head: Prof. Maurizio Zompatori), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy.Plastic Surgery Unit (Head: Dr. Riccardo Cipriani), S. Orsola-Malpighi Hospital, Bologna, Italy.Plastic Surgery Unit (Head: Dr. Riccardo Cipriani), S. Orsola-Malpighi Hospital, Bologna, Italy.Plastic Surgery Unit (Head: Dr. Riccardo Cipriani), S. Orsola-Malpighi Hospital, Bologna, Italy.Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28838837

Citation

Battaglia, Salvatore, et al. "Osteomyocutaneous Fibular Flap Harvesting: Computer-assisted Planning of Perforator Vessels Using Computed Tomographic Angiography Scan and Cutting Guide." Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery, vol. 45, no. 10, 2017, pp. 1681-1686.
Battaglia S, Maiolo V, Savastio G, et al. Osteomyocutaneous fibular flap harvesting: Computer-assisted planning of perforator vessels using Computed Tomographic Angiography scan and cutting guide. J Craniomaxillofac Surg. 2017;45(10):1681-1686.
Battaglia, S., Maiolo, V., Savastio, G., Zompatori, M., Contedini, F., Antoniazzi, E., ... Tarsitano, A. (2017). Osteomyocutaneous fibular flap harvesting: Computer-assisted planning of perforator vessels using Computed Tomographic Angiography scan and cutting guide. Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery, 45(10), pp. 1681-1686. doi:10.1016/j.jcms.2017.07.017.
Battaglia S, et al. Osteomyocutaneous Fibular Flap Harvesting: Computer-assisted Planning of Perforator Vessels Using Computed Tomographic Angiography Scan and Cutting Guide. J Craniomaxillofac Surg. 2017;45(10):1681-1686. PubMed PMID: 28838837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Osteomyocutaneous fibular flap harvesting: Computer-assisted planning of perforator vessels using Computed Tomographic Angiography scan and cutting guide. AU - Battaglia,Salvatore, AU - Maiolo,Vincenzo, AU - Savastio,Gabriella, AU - Zompatori,Maurizio, AU - Contedini,Federico, AU - Antoniazzi,Elisa, AU - Cipriani,Riccardo, AU - Marchetti,Claudio, AU - Tarsitano,Achille, Y1 - 2017/07/29/ PY - 2016/12/14/received PY - 2017/06/06/revised PY - 2017/07/24/accepted PY - 2017/8/26/pubmed PY - 2018/6/30/medline PY - 2017/8/26/entrez KW - Computed Tomographic Angiography KW - Computer-assisted surgery KW - Fibular free flap KW - Mandibular reconstruction KW - Perforator vessels SP - 1681 EP - 1686 JF - Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery JO - J Craniomaxillofac Surg VL - 45 IS - 10 N2 - INTRODUCTION: Mandibular reconstruction performed after virtual planning has become more common during recent years. The gold standard for extensive mandibular reconstruction is of course a fibular free flap. In designing an osteomyocutaneous fibula flap, poor planning, aberrant anatomy and/or inadequate perforator vessels are the most frequent causes of complications and may force the surgeon to modify the flap design, explore the contralateral leg or harvest an additional microvascular flap. The goal of our study was to pre-operatively evaluate the vascular anatomy of the fibula and localize the cutaneous perforator vessels, so to create the fibular cutting guide based on the position of the cutaneous perforator and safely harvest the reconstructive flap. MATERIALS AND METHODS: Twenty consecutive patients who were candidates for mandibular reconstruction using a fibular microvascular free flap were enrolled in this study between January 2016 and August 2016. The patients were preoperatively assessed with a Computed Tomographic scan of head and neck and with a Computed Tomographic Angiography (CTA) scan of the lower limbs to evaluate the vascular anatomy of the fibula. Virtual planning was carried out for all patients. The fibular cutting guide was based on the position of the perforator cutaneous vessels, which were used to harvest the cutaneous part of the flap. Preoperative CT measurements were performed in order to identify the cutaneous perforators on the patients' skin. Intraoperative checking was performed to evaluate the accuracy of the perforators' position and the reproducibility of the virtual planning. RESULTS: In 5 patients out of 20 (25%), anatomical anomalies were discovered, without clinical evidence. The perforator vessels were localized in all patients. The average difference between the CTA and the intraoperative perforator localization was 1 mm (range 0-2 mm). Fibular cutting guide was positioned and fitted the anatomy of the patients in all treated patients. This allowed us to perform the planned segmentation of the fibula, obtaining the correct number of segments. In all cases, flap insetting was carried out and skin paddle was positioned as preoperatively planned. Neither donor site complications nor flap complications occurred. CONCLUSIONS: Preoperative evaluation of the legs using CTA, in patients who undergo an osteomyocutaneous fibular free flap for mandibular reconstruction, is a valuable approach to reduce altered-anatomy related complications and to improve the accuracy and outcomes of the reconstruction, especially in reconstructions of complex defects. In these cases, a soft tissue-based cutting guide can be planned based on the perforator vessels of the skin paddle, minimizing the harvesting risks of vascular lesions. Further studies and longer follow-ups are needed to evaluate the long-term outcomes and advantages of this procedure. SN - 1878-4119 UR - https://www.unboundmedicine.com/medline/citation/28838837/Osteomyocutaneous_fibular_flap_harvesting:_Computer_assisted_planning_of_perforator_vessels_using_Computed_Tomographic_Angiography_scan_and_cutting_guide_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1010-5182(17)30255-X DB - PRIME DP - Unbound Medicine ER -