title: The microvascular corticocancellous femur flap for reconstruction of the anterior maxilla in adult cleft lip, palate, and alveolus patients.
abstract: OBJECTIVE
  Free nonvascularized alveolar bone grafting in severe defects of the cleft region often results in poor implant bed conditions. Here an alternative augmentation technique using a new technique of vascularized bone transfer is described.
  
  
  METHODS
  In five patients with clefts of the lip, palate, and alveolus (four unilateral, one bilateral) there was a severe defect of the anterior maxillary alveolar ridge after tooth loss. The patients previously had augmentative surgery one to three times without success. The defect was covered using a microvascular corticocancellous transplant from the medial distal femur. The defects to be corrected measured 2.5 to 4.0 cm long, 1.0 to 1.5 cm wide, and 1 to 1.5 cm high. The microvascular pedicle of the femur bone flap was 3 to 7 cm long. The descending genicular artery was anastomosed to the facial or labial superior artery and the accompanying veins accordingly. In every case, the anastomoses were performed via an intraoral transmucosal approach.
  
  
  RESULTS
  There were no serious complications and no flap loss. In all patients the defect was covered by a flap of the correct size and design. All patients were treated with dental implants (13 total) 6 months after successful reconstruction of the ridge. The implants were loaded 4 to 6 months after placement with fixed superstructures. There were good peri-implant conditions and no implant loss.
  
  
  CONCLUSIONS
  The microvascular osteoperiosteal femur flap can be used successfully in individual reconstruction of segmental defects of the alveolar ridge in adult cleft patients.
authors.affiliation: Clinic of Oral and Maxillofacial Surgery, Paracelsius Medical University/LKH Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.  a.gaggl@salk.at
authors.forename: Alexander
authors.initials: A
authors.lastname: Gaggl
authors.forename: Heinz
authors.initials: H
authors.lastname: Bürger
authors.forename: Sascha
authors.initials: S
authors.lastname: Virnik
authors.forename: Peter
authors.initials: P
authors.lastname: Schachner
authors.forename: Friedrich
authors.initials: F
authors.lastname: Chiari
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D005260:Female; D005269:Femur / Q000637:transplantation*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome