JPRAS Open最新文献_第6页

Global perspectives on practices and preferences in autologous free flap breast reconstruction: From flap selection to postoperative care A descriptive quantitative study 自体游离皮瓣乳房重建的实践和偏好：从皮瓣选择到术后护理一项描述性定量研究。

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-19 DOI: 10.1016/j.jpra.2024.10.010

Sanderley J. Bonafastia , Lennart M. Steenbeek , Dietmar J.O. Ulrich , Stefan Hummelink

Background

The purpose of this study was to evaluate the present-day practices in the preparation, peri-, and postoperative care for patients undergoing autologous free flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR.

Methods

A global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, enquiring about flap and donor site selection, surgical actions, perforator imaging, and perioperative care during ABR.

Results

Eighty-two responses were received, among which 71% (n=58) were completed questionnaires. The preferred flap of choice was the deep inferior epigastric perforator flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Preoperative imaging for ABR was typically performed using computed tomography angiography (75%, n=44) and often combined with a handheld Doppler. Handheld Doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.

Postoperatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and at reduced frequencies on subsequent days.

The most commonly used modality for monitoring flap viability was the handheld Doppler. The average length of hospital stay was 5 days.

Conclusion

This study provides valuable insights into the current preparations and peri- and postoperative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.

背景：本研究的目的是评估目前世界范围内接受自体游离皮瓣乳房重建（ABR）患者的准备，围手术期和术后护理的做法，旨在提高整形外科医生在ABR计划阶段的知情决策。方法：对全球280名整形外科医生和39个整形与重建外科学会进行调查，了解ABR中皮瓣和供体部位的选择、手术操作、穿支成像和围手术期护理。结果：共收到82份问卷，其中71% （n=58）完成问卷。首选的皮瓣是腹下深穿支皮瓣（85%,n=51），最常用的受体血管是乳腺内动脉。ABR的术前成像通常使用计算机断层血管造影（75%,n=44），通常结合手持式多普勒。手持式多普勒是术中定位穿支血管最常用的方式（33%,n=19），术中大多数使用一个（47%,n=24）或两个（51%,n=26）穿支。这些偏好在所有临床类型中都是一致的。术后，皮瓣监测主要由护理人员进行，最初在第一天每小时一次，随后几天减少频率。最常用的监测皮瓣活力的方式是手持式多普勒。平均住院时间为5天。结论：本研究为目前世界范围内ABR手术的准备和围术后护理提供了有价值的见解，有助于标准化实践的发展，并有可能改善患者的预后。

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引用次数: 0

Surgical management of a patient with severe and complex maxillofacial injuries caused by a bear mauling in the forest: A case report from Thailand 对一名在森林中被熊咬伤的严重复杂颌面部损伤患者的手术治疗：泰国病例报告

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-18 DOI: 10.1016/j.jpra.2024.10.009

Nutthawut Akaranuchat , Boonyaporn Kotistienkul , Wanchalerm Chungsiriwattana

A 60-year-old Thai male sustained severe and complex maxillofacial injuries, along with superficial neck and abdominal injuries, from being mauled by a black bear in Thailand. The accident caused massive injury to the face, including the right eye and periorbital soft tissue, right cheek, total nose, total upper lip, partial lower lip, and underlying bone structures. A computed tomography scan showed comminuted pan-facial fractures. Lifesaving procedures were performed at nearby hospitals, and then he was referred to our center one month after the injury. Our initial multi-stage surgical management strategy for treating this patient included debridement, right eyeball enucleation, coverage of the entire defect with anterolateral thigh with vastus lateralis chimeric free flap, and gastrostomy tube insertion to ensure appropriate nutrition. The next phase of treatment involved total nasal reconstruction with the two-stage folded paramedian forehead flap with cadaveric costal cartilage grafts. The outcomes of treatments provided the patient with spontaneous breathing via neonostrils and eating directly through his mouth. This case report demonstrates that satisfactory results can be achieved using a well-planned multi-stage reconstruction strategy.

一名 60 岁的泰国男性在泰国被一只黑熊咬伤，造成严重、复杂的颌面部损伤以及颈部和腹部表皮损伤。事故造成面部大面积损伤，包括右眼和眶周软组织、右脸颊、全鼻、全上唇、部分下唇和下部骨骼结构。计算机断层扫描显示，全脸粉碎性骨折。患者在附近医院进行了抢救，受伤一个月后被转到本中心。我们最初对该患者采取了多阶段手术治疗策略，包括清创、右眼球去核、用大腿前外侧带阔筋膜嵌合游离皮瓣覆盖整个缺损，以及插入胃造瘘管以确保适当的营养。下一阶段的治疗包括用两段式折叠副额部皮瓣和尸体肋软骨移植进行全鼻重建。治疗结果使患者能够通过新生鼻孔进行自主呼吸，并直接用嘴进食。本病例报告表明，采用精心策划的多阶段重建策略可以取得令人满意的效果。

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引用次数: 0

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: A two years retrospective analysis 酶清创后采用去细胞鱼皮移植个体化手术治疗：两年回顾性分析

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-18 DOI: 10.1016/j.jpra.2024.07.013

Gerrit Freund , Benedikt Schäfer, Justus P. Beier, Anja M. Boos

Over the past few years, treatment of burn injuries has evolved beyond primary surgical therapy with the development of enzymatic debridement and new types of skin replacement materials by providing complex personalized therapy concepts aimed at preserving and replacing the dermal layer of the skin.

The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and evaluate the outcomes of individualized combined treatment of mixed depth burn wounds with enzymatic debridement and decellularized fish skin.

A total of 18 patients with a mean age of 34.8 years and mean follow-up of 447.6 days were included. The mean total burn surface area was 12.3%. All patients received enzymatic debridement and an average area of 247.2 cm² of decellularized fish skin. Days until complete epithelization were 49.4 ± 25.79 days. No patient developed scar contracture or keloid. The Patient and Observer Scar Assessment Scale (POSAS) observer scale showed an overall impression average of 2.2 ± 0.83. The POSAS patient scale showed an overall impression average 2 ± 0.7. The Vancouver Scar Scale showed an average score of 1.89 ± 1.45. In conclusion, combined treatment using enzymatic debridement and decellularized fish skin, polylactide membrane, or split skin grafts allows for a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result in terms of the overall outcome of the developed scar tissue and could lead to a reduction in the area that requires autologous transplantation.

在过去的几年里，随着酶清创和新型皮肤替代材料的发展，烧伤的治疗已经超越了最初的手术治疗，提供了复杂的个性化治疗理念，旨在保护和替换皮肤的真皮层。本研究的目的是开发混合深度烧伤创面的个体化治疗算法，并评估酶清创和脱细胞鱼皮混合深度烧伤创面个体化联合治疗的效果。共纳入18例患者，平均年龄34.8岁，平均随访447.6天。平均总烧伤面积为12.3%。所有患者均接受酶清创，平均面积为247.2 cm2的脱细胞鱼皮。至上皮完全形成的时间为49.4±25.79天。无患者出现瘢痕挛缩或瘢痕疙瘩。患者与观察者疤痕评估量表（POSAS）观察者评分的总体印象平均值为2.2±0.83。POSAS患者评分总体印象平均为2±0.7。温哥华疤痕量表平均得分为1.89±1.45分。总之，使用酶清创和去细胞鱼皮、聚乳酸膜或裂皮移植的联合治疗可以为混合深度烧伤创面提供更个性化的治疗。研究发现，就瘢痕组织的整体结果而言，鱼皮提供了令人满意的结果，并且可以减少需要自体移植的区域。

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引用次数: 0

Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes 辐照患者乳房切除术后重建：对深下上腹肌穿孔器和背阔肌皮瓣效果的 12 年随访

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-18 DOI: 10.1016/j.jpra.2024.10.008

Åsa Edsander-Nord , Armin Assareh , Martin Halle , Ann-Charlott Docherty Skogh

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.

The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.

The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.

Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.

本研究的目的是对作者之前评估过的一组接受过乳房切除术后乳房重建术的辐照患者进行为期 12 年的随访，这些患者接受了带假体的深下上腹部穿孔器 (DIEP) 和背阔肌 (LD) 皮瓣重建术。患者报告的结果测量（PROMS）采用 BREAST-Q、SF-36、满意度表以及手臂、肩部和手部残疾（DASH）问卷进行测量。平均随访时间为 12.6 年（DIEP）和 11.8 年（LD）。15 名 DIEP 和 9 名 LD 患者接受了对侧对称手术。两组患者平均接受了 2.5 次重建手术。BREAST-Q 和满意度问卷调查显示两组患者无差异。SF-36 没有显示出组别差异，但与普通人群相比，两组患者在身体角色限制方面的数值明显更高（分别为 p=0.034 和 p=0.004）。美学评估显示，患者和外科医生的意见存在差异，DIEP组患者对重建乳房的大小（p=0.015）和整体美感（p=0.012）的评价更高。加权卡帕分析显示，患者与外科医生之间的一致性较差。随着时间的推移，患者的偏好从LD皮瓣转向DIEP皮瓣，这可能是由于自体重建的自然衰老过程。这强调了长期随访研究的重要性。

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引用次数: 0

An Optimal Scalp Rotation Flap Design: Mathematical and Bio-Mechanical Analysis 最佳头皮旋转瓣设计：数学与生物力学分析。

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-17 DOI: 10.1016/j.jpra.2024.10.007

Paul Machado , Terry Le , Warren M. Rozen , David J. Hunter-Smith , Vachara Niumsawatt

The design and implementation of successful rotational flaps of the scalp remains a complex process. There are several described techniques, all of which are based on a two-dimension surface, absent consideration of the convexity, and thereby three-dimensional nature of the scalp. This has contributed to flaps that are either too small or unnecessarily large in a bid to compensate. Mathematical analysis using trigonometric and algebraic formulas was used to derive the relationship between the defect, triangulation, the contour of the scalp, the radius of the arc of rotation for the flap, and scalp skin tension. Polyurethane models were used to test the applicability of the resultant formula, and a consecutive clinical case series is presented. Rotation flap dimensions were calculated using an apex angle of 30° depicted as a two-dimensional construct. The contour of the defect was then measured as the depth of depression with radius of the rotation flap calculated based on the changes in flap surface area across the defect. Finite element analysis was used to measure redistribution of tension along the flap reconstructing the defect, and the efficacy of the approach was confirmed in the consecutive clinical series. This study provides a reliable flap design based on mathematical analysis, with evidence-based application to the clinical setting.

成功的头皮旋转皮瓣的设计和实施仍然是一个复杂的过程。有几种描述的技术，所有这些技术都是基于二维表面，没有考虑到头皮的凹凸性，因此头皮的三维性质。这导致襟翼要么太小，要么太大，以弥补。利用三角函数和代数公式进行数学分析，推导出缺损、三角剖分、头皮轮廓、皮瓣旋转弧半径和头皮皮肤张力之间的关系。使用聚氨酯模型来测试所得公式的适用性，并提出了连续的临床病例系列。旋转皮瓣的尺寸计算使用顶点角30°描绘为二维结构。然后测量缺陷的轮廓作为凹陷深度，根据皮瓣表面积的变化计算出旋转皮瓣的半径。采用有限元分析测量沿皮瓣重建缺损的张力再分布，并在连续的临床系列中证实了该方法的有效性。本研究提供了一种基于数学分析的可靠皮瓣设计，并以证据为基础应用于临床。

{"title":"An Optimal Scalp Rotation Flap Design: Mathematical and Bio-Mechanical Analysis","authors":"Paul Machado , Terry Le , Warren M. Rozen , David J. Hunter-Smith , Vachara Niumsawatt","doi":"10.1016/j.jpra.2024.10.007","DOIUrl":"10.1016/j.jpra.2024.10.007","url":null,"abstract":"<div><div>The design and implementation of successful rotational flaps of the scalp remains a complex process. There are several described techniques, all of which are based on a two-dimension surface, absent consideration of the convexity, and thereby three-dimensional nature of the scalp. This has contributed to flaps that are either too small or unnecessarily large in a bid to compensate. Mathematical analysis using trigonometric and algebraic formulas was used to derive the relationship between the defect, triangulation, the contour of the scalp, the radius of the arc of rotation for the flap, and scalp skin tension. Polyurethane models were used to test the applicability of the resultant formula, and a consecutive clinical case series is presented. Rotation flap dimensions were calculated using an apex angle of 30° depicted as a two-dimensional construct. The contour of the defect was then measured as the depth of depression with radius of the rotation flap calculated based on the changes in flap surface area across the defect. Finite element analysis was used to measure redistribution of tension along the flap reconstructing the defect, and the efficacy of the approach was confirmed in the consecutive clinical series. This study provides a reliable flap design based on mathematical analysis, with evidence-based application to the clinical setting.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"43 ","pages":"Pages 251-264"},"PeriodicalIF":1.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From Novel Facial Measurements to Facial Implantology: A Systematic Review 从新式面部测量到面部种植学：系统回顾

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-17 DOI: 10.1016/j.jpra.2024.10.005

Helena Baecher , Alexandra Scheiflinger , Katya Remy , Niklas Straub , Bhagvat Maheta , Khalil Sherwani , Can Deniz , Samuel Knoedler , Ali-Farid Safi , Martin Kauke-Navarro , Max Heiland , Leonard Knoedler

Background

Facial implants have emerged as pivotal tools for both reconstructive and aesthetic skull bone augmentation. Contemporary manufacturing techniques, such as computer-aided design and manufacturing (CAD-CAM) systems, have revolutionized facial implants production, providing the advantages of high-level individualization. However, the absence of standardized facial measurements complicates the ability to accurately compare outcomes across various techniques. This systematic review investigates the strengths and limitations of various facial measurements employed in facial implants, with a particular focus on their impact on aesthetic outcomes and potential complications.

Methods

We identified 13 studies in our comprehensive search across PubMed/MEDLINE, Web of Science, EMBASE, and CENTRAL databases.

Results

In total, 620 patients were included. The majority of the chosen studies focused on aesthetic purposes (69%). Primarily, mandibular (46%) or nasal regions (23%) were investigated, with porous polyethylene (31%), silicone (23%), and polyetheretherketone (23%) being the most utilized materials. Despite considerable heterogeneity in measurement approaches, including variations in reference points and angles, complications such as surgical site infections and nerve-related injuries were reported in the included studies.

Conclusion

Our review highlights the importance of standardized facial analysis for optimal implant planning. Future research should prioritize the development of uniform measurement concepts tailored to diverse implant applications to enhance outcomes and patient satisfaction in facial implantation.

背景面部植入物已成为重建和美学颅骨增量的重要工具。计算机辅助设计和制造（CAD-CAM）系统等现代制造技术彻底改变了面部植入物的生产，提供了高度个性化的优势。然而，由于缺乏标准化的面部测量方法，因此无法准确比较各种技术的效果。这篇系统性综述研究了面部植入物中采用的各种面部测量方法的优势和局限性，尤其关注它们对美学效果和潜在并发症的影响。方法我们在PubMed/MEDLINE、Web of Science、EMBASE和CENTRAL数据库中进行了全面搜索，确定了13项研究。所选研究大多以美学为目的（69%）。研究对象主要是下颌（46%）或鼻腔（23%），使用最多的材料是多孔聚乙烯（31%）、硅胶（23%）和聚醚醚酮（23%）。尽管测量方法存在相当大的差异，包括参考点和角度的不同，但所纳入的研究都报告了手术部位感染和神经相关损伤等并发症。未来的研究应优先发展适合不同植入应用的统一测量概念，以提高面部植入的效果和患者满意度。

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引用次数: 0

Semiautomatic Quantitative Assessment of DIEP Flap Volume and Thickness for Breast Reconstruction using CTA Data and Implications in Postoperative Complications 利用 CTA 数据半自动定量评估用于乳房重建的 DIEP 皮瓣体积和厚度及其对术后并发症的影响

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-16 DOI: 10.1016/j.jpra.2024.10.003

María A. Cerón Hurtado , Sergi Barrantes , Antonio Sánchez Egea , Farners Armengol Siñol , Hernán González Rojas , Anna Padullés-Escarré , Jose A Jerez-Gonzalez , Anna López Ojeda , Joan Fontdevila Font

Accurately assessing flap volume and thickness is a crucial aspect of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap, especially in challenging cases such as thin or large-breasted women or bilateral reconstruction. To address this, we present an innovative image processing tool utilizing computed tomography angiography (CTA) to measure DIEP flap volume and thickness. Our approach incorporates an elliptical equation validated on DIEP reconstruction patients. Preoperative abdominal CTA images were obtained from 70 patients who underwent DIEP flap breast reconstruction at Hospital Universitari de Bellvitge from 2017 to 2021. The image processing tool was employed for preoperative quantification, utilizing elliptical approximations, to determine the volume to be harvested and assess the central thickness of the flap. Subsequently, a non-parametric statistical retrospective analysis was conducted to examine these parameters in relation to immediate complications. The mean maximum recruitable volume (MRV) was 1017.15 ± 325.51 cm³, with a mean thickness of 3.65 ± 1.14 cm. No significant correlation was found between postoperative complications and MRV or thickness values. The processing tool offers a reliable solution for accurately measuring the volume and thickness of the DIEP flap from CTA images, aiding surgeons in breast reconstruction decision-making. This innovative approach enhances surgical planning by addressing quantitative values of thickness and volume of the DIEP flap, which is critical for accurate flap assessment.

准确评估皮瓣的体积和厚度是使用深下上腹肌穿孔器（DIEP）皮瓣进行乳房重建的一个关键环节，尤其是在一些具有挑战性的病例中，如瘦、大胸或双侧重建的女性。为此，我们提出了一种创新的图像处理工具，利用计算机断层血管成像（CTA）来测量 DIEP 皮瓣的体积和厚度。我们的方法结合了在 DIEP 重建患者身上验证过的椭圆方程。从2017年到2021年，在贝尔维奇大学医院接受DIEP皮瓣乳房重建术的70名患者获得了术前腹部CTA图像。该图像处理工具用于术前量化，利用椭圆近似值确定要切除的体积，并评估皮瓣的中心厚度。随后，进行了非参数统计回顾性分析，研究这些参数与即刻并发症的关系。平均最大可采集体积（MRV）为 1017.15 ± 325.51 立方厘米，平均厚度为 3.65 ± 1.14 厘米。术后并发症与 MRV 或厚度值之间没有明显的相关性。该处理工具为从 CTA 图像中精确测量 DIEP 皮瓣的体积和厚度提供了可靠的解决方案，有助于外科医生做出乳房重建决策。这种创新方法通过处理 DIEP 皮瓣厚度和体积的定量值来增强手术规划，这对准确评估皮瓣至关重要。

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引用次数: 0

Salvage of anterolateral thigh (ALT) flap with indocyanine green assessment of a flap pedicle and subsequent perforator-to-perforator anastomosis 用吲哚菁绿评估皮瓣蒂和后续穿孔器与穿孔器吻合术挽救大腿前外侧（ALT）皮瓣

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-16 DOI: 10.1016/j.jpra.2024.10.001

Petko Shtarbanov , Nianhe Luo , Ahmed Yassin , Dariush Nikkhah

Indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative method to accurately assess real-time tissue vascularity, perfusion and anastomotic patency in flap surgery. We illustrate a complex case of elbow reconstruction in an elderly patient with a free anterolateral thigh flap, which relied on intraoperative ICG to evaluate the flap pedicle and map the site of arterial occlusion. Supermicrosurgical instrumentation was employed to perform complex perforator-to-perforator anastomosis following resection of the vascular site of the lesion. These unique applications in a patient of known surgical risk enabled immediate flap salvage, and after 6 months postoperatively, the flap remained healthy with adequate wound healing.

吲哚菁绿（ICG）荧光血管造影术已成为一种术中方法，用于准确评估皮瓣手术中组织血管的实时性、灌注和吻合口的通畅性。我们展示了一例使用游离大腿前外侧皮瓣为老年患者进行肘部重建的复杂病例，该病例依靠术中 ICG 评估皮瓣蒂和绘制动脉闭塞部位图。在切除病变血管部位后，采用超显微外科器械进行了复杂的穿孔器与穿孔器吻合术。在已知有手术风险的患者身上进行这些独特的应用，可以立即挽救皮瓣，术后 6 个月后，皮瓣仍然健康，伤口充分愈合。

引用次数: 0

Role of residual mandibular teeth after computer-assisted mandibular reconstruction using a fibular flap 使用腓骨瓣进行计算机辅助下颌骨重建后残留下颌牙的作用

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-16 DOI: 10.1016/j.jpra.2024.10.002

Koreyuki Kurosawa , Akira Ohkoshi , Ryo Ishii , Naoko Sato , Hitoshi Miyashita , Takayuki Harata , Toshiro Imai , Masanobu Hayashi , Shinyo Ishi , Miki Shoji , Yoshimichi Imai

Background

Computer-assisted mandibular reconstruction after mandibulectomy enables accurate reconstruction of the occlusal positions between the maxilla and mandible. Understanding the remaining teeth condition is essential for sensory mastication in patients with numerous tooth loss. However, no studies have examined the dental status of the remaining mandible after computer-assisted mandibular reconstruction using a fibular flap. This study evaluated the role of residual teeth and other factors in effective acquisition of oral intake after computer-assisted mandibular reconstruction using a fibular flap.

Patients and Methods

Postoperative oral intake and associated factors were retrospectively examined in 57 consecutive patients. Oral intake was assessed using the Functional Oral Intake Scale. Multivariate analysis was performed to evaluate the remaining teeth arrangement (Eichner's classification), mandibular dentures, extent of resection (Brown's classification), age, performance of glossectomy, history of radiation therapy, and computer-assisted methods.

Results

Multivariate analysis revealed that Eichner's classification had a positive (p<0.001) and radiation therapy had a negative (p<0.05) impact on oral intake. The patients with dentures anchored to the remaining teeth in the occlusal support area (i.e., premolar and molar) had higher Functional Oral Intake score than those with dentures anchored to the remaining teeth in the non-occlusal support area (6.78±0.03 vs. 6.10±0.07, p<0.005).

Conclusion

In computer-assisted mandibular reconstruction with accurate occlusion, the residual teeth in the occlusal support area are essential for good postoperative oral intake with dentures. During mandibulectomy, if oncologically acceptable, these teeth should be preserved, and selective placement of dental implants in the occlusal support area should be considered.

背景下颌骨切除术后的计算机辅助下颌骨重建可以准确重建上颌骨和下颌骨之间的咬合位置。了解剩余牙齿的状况对大量牙齿缺失患者的感觉咀嚼至关重要。然而，目前还没有研究对使用腓骨瓣进行计算机辅助下颌骨重建后剩余下颌骨的牙齿状况进行研究。本研究评估了残留牙齿和其他因素在使用腓骨瓣进行计算机辅助下颌骨重建后有效获得口腔摄入量中的作用。患者和方法对 57 名连续患者的术后口腔摄入量和相关因素进行了回顾性研究。口腔摄入量采用功能性口腔摄入量表进行评估。结果多变量分析显示，Eichner 分级对口腔摄入量有积极影响（p<0.001），而放射治疗对口腔摄入量有消极影响（p<0.05）。与将假牙固定在非咬合支持区剩余牙齿上的患者相比，将假牙固定在咬合支持区剩余牙齿上的患者（6.78±0.03 vs. 6.10±0.07，p<0.005）具有更高的功能性口腔摄入评分。在下颌骨切除术中，如果肿瘤学上可以接受，应保留这些牙齿，并考虑有选择性地在咬合支持区植入种植体。

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引用次数: 0

Severe facial trauma secondary to aircraft propeller injury: The art of facial reconstruction 飞机螺旋桨造成的严重面部创伤：面部重建艺术

IF 1.5 Q3 SURGERY

JPRAS Open

Pub Date : 2024-10-12 DOI: 10.1016/j.jpra.2024.10.004

Yusef Jiménez-Murat , Kevin Fuentes-Calvo , Kenzo A. Fukumoto-Inukai , Rogelio Martínez-Wagner

The reconstruction of complex facial trauma poses a significant challenge for plastic surgeons, as it requires a multidisciplinary approach to achieve both functional and aesthetic outcomes. Moreover, it represents a substantial burden on public health. In severe facial trauma, initial management to rule out life-threatening conditions through Advanced Trauma Life Support (ATLS) is crucial. Expertise in soft tissue reconstruction and facial fracture management is essential to achieve good results. New reconstruction techniques include free flaps, grafts, expanders, and epidermal grafts.

Here, we present the case of a 68-year-old male who suffered facial trauma from an aircraft propeller managed through staged reconstructive surgical techniques. We will describe surgical management, emphasizing the methods and outcomes. The primary objective of this study is to provide insights into the clinical challenges and therapeutic strategies in managing severe facial trauma, underscoring the critical importance of an interdisciplinary approach to achieve successful and functional facial reconstruction.

复杂面部创伤的重建对整形外科医生来说是一个巨大的挑战，因为它需要多学科方法来实现功能和美学效果。此外，这也是公共卫生的一大负担。在严重的面部创伤中，通过高级创伤生命支持（ATLS）来排除危及生命的情况是至关重要的。软组织重建和面部骨折处理方面的专业知识对取得良好效果至关重要。新的重建技术包括游离皮瓣、移植物、扩张器和表皮移植物。在此，我们将介绍一例因飞机螺旋桨造成面部创伤的 68 岁男性病例，该病例通过分阶段重建手术技术进行了处理。我们将对手术治疗进行描述，重点介绍手术方法和结果。本研究的主要目的是提供有关处理严重面部创伤的临床挑战和治疗策略的见解，强调跨学科方法对于实现成功的功能性面部重建至关重要。

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引用次数: 0