Title: A new approach in the reconstruction of the midface and mandible with a microvascularized fibular flap
Abstract:
Introduction: The resection of facial tumors that affect the maxilla and mandible has left significant sequelae. But the question arises: What factors contribute to large resections of oral tumors? Are they tumors that affect the face and make us more sensitive to their destruction, and are they caused by failure in prevention? Each surgical process is a challenge, especially when there is a great reconstruction to be carried out due to the anatomical defect created by the resection of cancer in the region of the head and neck, which motivates the development of new reconstruction techniques. The possibility of using microvascular flaps for reconstruction has improved the quality of life of cancer patients through the return of masticatory function, speech, and aesthetics. Reconstructions with microvascularized fibula flaps are a routine in our institution, which makes us seek alternatives to provide greater comfort to patients, covering issues of return to function and aesthetics, which is a challenge for each patient, since the main objective is to improve quality of life and provide the patient's reintegration into society.
Objective: To demonstrate reconstructions with microvascularized fibular flaps in large defects in the mandible and a new technique for reconstruction of the zygomatic-maxillary complex and orbital floor, due to the difficulty of rotating soft tissues and the pedicle.
Method:
-
For patients who require complementary therapy with radiotherapy, there is a safety period to perform or indicate radiation treatment. With the variables of greater contact surface between the segments, which facilitates bone neoformation and flap stability, thus reducing the chance of loss of bone segments or necrosis.
-
(New technique) After harvesting the free fibular flap in the standard form, differentiated osteotomies, modeling and arrangement of the fibular bone segments are performed at the recipient site of the middle third of the face.
Result: These variables in the reconstruction technique of the microvascularized fibular flap resulted in a satisfactory result in aesthetics and function.
Conclusion: These variables in the reconstruction technique of the microvascularized fibular flap with satisfactory results in aesthetics and function, especially when we fail to prevent oral cancer. The new techniques presented have the advantage of requiring only one flap in reconstruction, thus resolving the technical difficulties of the middle third of the face. It is believed that the technique described can contribute to the return of function, anatomy of the maxilla and mandible, speech and aesthetics of the patient, in addition to aiding in the recovery of newly formed bone tissue.
