title: Pedicle Orientation in Free-Flap Microvascular Maxillofacial Reconstruction.
abstract: Oncologic and traumatic defects of the maxilla can pose a challenge to patients, reconstructive surgeons, and maxillofacial prosthodontists in an attempt to provide satisfactory treatment. Oral-nasal and oral-antral fistulas are frequently treated with soft tissue flaps, osteocutaneous flaps, or a maxillofacial obturator. The free fibula microvascular osteocutaneous flap has proved the workhorse of these maxillary and mandibular reconstructions. The success of microvascular reconstruction often hinges on flap viability in the immediate postoperative period. With most flap failures attributed to vascular compromise resulting from clot formation and venous congestion, uncompressed, and nontortuous pedicle positioning demands surgical attention. Although the use of the free fibula flap in maxillary reconstruction is a well-described and predictable procedure, the specifics of the flap inset with respect to pedicle positioning and technique within the maxilla and neck have not been clearly detailed in the available studies. In the present technique note, we have provided our surgical description for pedicle positioning and anatomic alterations in an attempt to improve microvascular anastomosis flap success.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address: dcummi@lsuhsc.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cummins
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Beomjune
authors.initials: B
authors.lastname: Kim
authors.affiliation: Current Fellow, Oral, Head and Neck Oncology and Microvascular Reconstructive Surgery, Head and Neck Surgical Associates, Portland, OR.
authors.forename: Arshad
authors.initials: A
authors.lastname: Kaleem
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Zaid
mesh_terms: D005360:Fibula / Q000098:blood supply* / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*