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ISRN Surgery  2012 

Free Microsurgical and Pedicled Flaps for Oncological Mandibular Reconstruction: Technical Aspects and Evaluation of Patient Comorbidities

DOI: 10.5402/2012/792674

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Abstract:

Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at our institution. The free fibular flap is now considered the gold standard for mandibular reconstruction. However, in patients with multiple comorbidities, lengthy procedures may be less optimal and pedicled flaps, with specific modifications, can yield reasonable outcomes. Technical aspects and comorbidity profiles are examined in the oncological mandibular reconstruction cohort. 1. Introduction Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. The goals of reconstruction, following oncologic resection, are both functional and aesthetic. Functional considerations include successful wound closure of the oropharynx, preservation of a patent upper airway, phonation, mastication, and potential for dental rehabilitation, in addition to restoration of aesthetic impairment. The principles that guide oncologic mandibular reconstruction focus on optimizing outcomes and identifying ideal flap reconstruction, with consideration of patient co-morbidities and reconstructive requirements. Reconstruction with pedicled pectoralis major myocutaneous and deltopectoral flaps used to be the standard of care and continues to be in selected cases [1]. Free-flap reconstruction of oncologic defects has become the modern standard of care, largely due to superior functional and aesthetic outcomes [2]. However, in patients with multiple co-morbidities, who cannot tolerate lengthy surgery or fluid shifts, pedicled flaps may be best suited to meet the reconstructive requirements. 2. Materials and Methods Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at the University of Illinois at Chicago Medical Center. Institutional Review Board approval was obtained. All patients who underwent oncological mandibular reconstruction were included in this study, representing a single surgeon’s experience (A. K. Antony) from October of 2010 to May of 2011. Medical records were retrospectively reviewed to further characterize comorbid conditions and technical modifications employed to optimize results. The following

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