Prefabricated bony radial forearm flap for secondary mandible reconstruction after radiochemotherapy.
BACKGROUND
Primary reconstruction of the mandible is the golden standard of surgical treatment after ablative tumor surgery. Many different microvascular bone grafts are used to reduce wound healing complications at the severely compromised recipient site. The loss of primary grafts due to radiotherapy or osteoradionecrosis can make secondary mandibular reconstruction necessary. To address this problem, we developed the technique of the prefabrication of a radial forearm flap with cancellous bone. The aims were to establish these techniques into the clinical routine and to create a safe and reliable flap with low donor site morbidity.


METHODS
In patients who had undergone ablative tumor surgery radiochemotherapy, and primary reconstruction, prefabricated bony radial forearm flaps (PBRFFs) were applied for secondary reconstruction of the mandible. Cylinders of cancellous bone taken from the iliac crest were implanted in the lower forearm to allow the necessary vascularization. After a healing period of 4 weeks, the PBRFF was elevated and grafted into the mandibular defect.


RESULTS
All grafts healed uneventfully. However, 1 case required revision of the venous anastomosis after 2 days. The transplants improved the contour of the lower face enabling a good correction of the facial asymmetry. During the follow-up of up to 4 years, the radiographic controls showed good bony consolidation between the graft and the stumps of the mandible as well as formation of cortical bone around the cancellous bone cylinders.


CONCLUSIONS
These results demonstrate that the PBRFF is a safe and reliable graft which provides alternate solution in which other microvascular bone grafts have already failed. In the future, the iliac bone graft may be replaced with scaffold seeded with stem cells for further reduction of donor site morbidity.
Leonhardt
Henry
H
Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
Pradel
Winnie
W
Mai
Ronald
R
Markwardt
Jutta
J
Lauer
Günter
G
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011788:Quality of Life; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D011884:Radius / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome