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1.
Ann Plast Surg ; 80(5): 475-480, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29401131

RESUMO

BACKGROUND: The acceptance of nipple-sparing mastectomy for the treatment of breast cancer in selected patients has introduced ancillary procedures to improve breast shape, correct ptosis, and enhance breast symmetry. Mastopexy before or at the time of nipple-sparing mastectomy has been performed to correct ptosis, but there have been no reports on secondary Wise pattern mastopexy after completion of staged subcutaneous expander/implant reconstruction. METHODS: Between 2005 and 2015, 155 patients (255 breasts) underwent staged subcutaneous implant/expander-based reconstruction after inframammary nipple-sparing mastectomy. Of the 155 patients, 10 (6.5%) patients required a secondary Wise pattern mastopexy (n = 14, 5.5%). The nipple was raised 2.5 to 6 cm (range, 3.8 cm), and the implant location was adjusted accordingly for optimal positioning with respect to the nipple-areola. The secondary mastopexy was performed to correct ptosis, improve breast symmetry and/or contour deformities of the breast, and relieve pain associated with large implants. RESULTS: All mastopexies healed without complications, and the goals of the revisions were achieved. There were no capsular contractures after an average of 50 months (range, 19-92 months). The patients were satisfied with the aesthetic and functional improvement. CONCLUSIONS: Secondary mastopexy after 2-stage subcutaneous expander/implant breast reconstruction is uncommon, but if needed, it may be safely performed to correct ptosis and improve breast shape, symmetry, and function.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/cirurgia , Adulto , Implantes de Mama , Estética , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Dispositivos para Expansão de Tecidos , Resultado do Tratamento
2.
Ann Plast Surg ; 77(4): 388-95, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26418778

RESUMO

BACKGROUND: Patients undergoing nipple-sparing mastectomy and immediate-implant based reconstruction occasionally require a mastopexy based on their breast size and degree of ptosis. Previous reports have shown the feasibility of mastopexy-nipple-sparing mastectomy in selected patients to raise the nipple up to 5 cm. Major mastopexy with nipple transposition more than 6 cm in conjunction with nipple-sparing mastectomy for therapeutic indications has not been described. The authors review their experience with primary buttonhole mastopexy performed in conjunction with nipple-sparing mastectomy. METHODS: Between 2008 and 2014, 16 patients (32 breasts) underwent bilateral primary mastopexy and nipple-sparing mastectomy with immediate staged implant-based reconstruction. The Passot buttonhole technique was used for the mastopexy in all patients, raising the nipple from 7 to 12 cm. Tumor-related data, risk factors, breast size, degree of ptosis, expander size, fill volume, selection criteria, and complications are discussed. RESULTS: The average follow-up period was 33 months (range, 14 to 80 months). There were no tumor recurrences, and all patients completed their reconstruction. Two patients required removal of the expander and delayed reconstruction because of infection and implant exposure due to nipple-areola loss. The reasons for nipple-areola loss and technical modifications to enhance skin viability by retaining a thin layer of subareolar breast tissue for removal during the second-stage implant exchange are discussed. CONCLUSIONS: Primary mastopexy using the buttonhole technique performed together with nipple-sparing mastectomy is a safe procedure with predictable results in patients with very large or ptotic breasts requiring lifts greater than 6 cm. The success of the combined procedure depends on preserving a thin layer of subareolar breast tissue and removing it at the time of implant exchange.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Mamilos/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
3.
Plast Reconstr Surg ; 151(6): 1002e-1014e, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-36728611

RESUMO

BACKGROUND: Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors' microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this article, the authors review stages 2 through 5, using a forehead flap and rib grafts to resurface the nose and build a support framework. The authors examine their complications, long-term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges. METHODS: Thirty-eight full-thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function, and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor. RESULTS: Repair was completed in 35 of 38 patients. Fifty percent of patients returned an anonymous survey; 85% were very satisfied; 75% declared excellent, very good, or good breathing; 75% used stents never/rarely; 95% appeared normal; and 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair, and 3% poor. CONCLUSION: A folded radial forearm lining flap, a three-stage full-thickness forehead flap for cover, and a late revision can repair difficult nasal defects, as shown in a large series of patients with long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias Nasais , Procedimentos de Cirurgia Plástica , Rinoplastia , Humanos , Rinoplastia/métodos , Qualidade de Vida , Neoplasias Nasais/cirurgia , Nariz/cirurgia , Nariz/irrigação sanguínea
4.
Plast Reconstr Surg ; 150(3): 513-522, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35749533

RESUMO

BACKGROUND: Prepectoral reconstruction following nipple-sparing mastectomy has recently gained popularity as an alternative to total or partial submuscular reconstruction. In the absence of long-term follow-up, concerns have been raised over the oncologic safety of using mastectomy flaps that preserve the entire thickness of the subcutaneous fat and its circulation. In this article, the authors present their average 9-year oncologic follow-up of patients who underwent nipple-sparing mastectomy and two-stage prepectoral implant reconstruction without acellular dermal matrix. METHODS: In this retrospective study, a group of previously reported (151 consecutive) breast cancer patients [246 breasts (160 therapeutic and 86 preventative)] who underwent nipple-sparing mastectomy and staged prepectoral implant reconstruction between 2005 and 2015 were followed up for an average of 109 months (range, 14 to 192 months). Tumor-related data, oncologic markers, staging, neoadjuvant/adjuvant therapy, and radiation therapy were evaluated to determine local recurrence, overall survival, and disease-free survival rates. RESULTS: The local recurrence rate in 151 patients was 2.6 percent. Eleven patients (7.3 percent) died as a result of metastatic disease and three patients died as a result of unrelated causes. The average 109-month overall survival rate was 92.9 percent, and the disease-free survival rate was 87.8 percent. Over the same period, nine patients (6 percent) were alive with distant disease. CONCLUSION: The authors' 9-year two-stage prepectoral reconstruction study of nipple-sparing mastectomy shows that the procedure is oncologically safe, having comparable recurrence, overall survival, and disease-free survival rates as total mastectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implantes de Mama , Neoplasias da Mama , Mamoplastia , Mastectomia Subcutânea , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/métodos , Mastectomia/métodos , Mastectomia Subcutânea/efeitos adversos , Mastectomia Subcutânea/métodos , Mamilos/cirurgia , Estudos Retrospectivos
5.
Ann Surg Oncol ; 18(4): 917-22, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21308484

RESUMO

BACKGROUND: The use of areola-sparing (AS) or nipple-areola-sparing (NAS) mastectomy for the treatment or risk reduction of breast cancer has been the subject of increasing dialogue in the surgical literature over the past decade. We report the initial experience of a large community hospital with AS and NAS mastectomies for both breast cancer treatment and risk reduction. METHODS: A retrospective chart review was performed of patients undergoing either AS or NAS mastectomies from November 2004 through September 2009. Data collected included patient sex, age, family history, cancer type and stage, operative surgical details, complications, adjuvant therapies, and follow-up. RESULTS: Forty-three patients underwent 60 AS and NAS mastectomies. Forty-two patients were female and one was male. The average age was 48.7 years (range, 28-76 years). Forty mastectomies were for breast cancer treatment, and 20 were prophylactic mastectomies. The types of cancers treated were as follows: invasive ductal (n = 19), invasive lobular (n = 5), ductal carcinoma-in situ (n = 15), and malignant phyllodes (n = 1). Forty-seven mastectomies (78.3%) were performed by inframammary incisions. All patients underwent immediate reconstruction with either tissue expanders or permanent implants. There was a 5.0% incidence of full-thickness skin, areola, or nipple tissue loss. The average follow-up of the series was 18.5 months (range, 6-62 months). One patient developed Paget's disease of the areola 34 months after an AS mastectomy (recurrence rate, 2.3%). There were no other instances of local recurrence. CONCLUSIONS: AS and NAS mastectomies can be safely performed in the community hospital setting with low complication rates and good short-term results.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/cirurgia , Mastectomia , Mamilos/cirurgia , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/prevenção & controle , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/prevenção & controle , Carcinoma Lobular/patologia , Carcinoma Lobular/prevenção & controle , Feminino , Seguimentos , Hospitais Comunitários , Humanos , Pessoa de Meia-Idade , Mamilos/patologia , Estudos Retrospectivos , Comportamento de Redução do Risco , Taxa de Sobrevida , Resultado do Tratamento
6.
Plast Reconstr Surg ; 147(2): 305-315, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177453

RESUMO

BACKGROUND: In the past decade, surgeons have increasingly advocated for a return to prepectoral breast reconstruction with claims that surgical mesh (including acellular dermal matrix) can reduce complication rates. However, numerous surgical and implant advancements have occurred in the decades since the initial prepectoral studies, and it is unclear whether mesh is solely responsible for the touted benefits. METHODS: The authors conducted a systematic review of all English language articles reporting original data for prepectoral implant-based breast reconstruction. Articles presenting duplicate data were excluded. Complications were recorded and calculated on a per-breast basis and separated as mesh-assisted, no-mesh prior to 2006, and no-mesh after 2006 (date of first silicone gel-filled breast implant approval). Capsular contracture comparisons were adjusted for duration of follow-up. RESULTS: A total of 58 articles were included encompassing 3120 patients from 1966 to 2019. The majority of the included studies were retrospective case series. Reported complication outcomes were variable, with no significant difference between groups in hematoma, infection, or explantation rates. Capsular contracture rates were higher in historical no-mesh cohorts, whereas seroma rates were higher in contemporary no-mesh cohorts. CONCLUSIONS: Limited data exist to understand the benefits of surgical mesh devices in prepectoral breast reconstruction. Level I studies with an appropriate control group are needed to better understand the specific role of mesh for these procedures. Existing data are inconclusive but suggest that prepectoral breast reconstruction can be safely performed without surgical mesh.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Contratura Capsular em Implantes/epidemiologia , Telas Cirúrgicas/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Remoção de Dispositivo/estatística & dados numéricos , Estética , Feminino , Humanos , Contratura Capsular em Implantes/etiologia , Contratura Capsular em Implantes/cirurgia , Mastectomia/efeitos adversos , Músculos Peitorais/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
7.
Plast Reconstr Surg ; 144(1): 199-210, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246830

RESUMO

BACKGROUND: Microvascular reconstruction of the nose was pioneered in China in the early 1970s using the radial forearm flap. Since then, different flaps, methods, and flap designs have been used to improve outcomes. Microvascular tissue transfer has become the first step of multistage reconstruction, which includes rebuilding the nasal framework, transferring a forehead flap for external skin coverage, and sculpting the nose for improved appearance and breathing. In this article, the authors present their long-term experience in microvascular reconstruction of the nose using the infolded radial forearm flap for full-thickness nasal defects, and a single circumferential flap for inner lining only. METHODS: Fifty microvascular nasal reconstruction procedures were performed on 47 patients between 2000 and 2017 using the radial forearm flap. The reconstructions included total/subtotal nasal defects using a trapezoid-shaped forearm flap folded in one or two planes, and a rectangular flap positioned internally and circumferentially for lining only. The nasal defects were caused by cancer resection, trauma, infection, cocaine abuse, and failed attempts at nasal reconstruction. RESULTS: Forty-seven flaps were transferred successfully for nasal reconstruction, with two immediate failures (4 percent) caused by flap insetting complications and one late loss. Forty-six patients completed the multistage nasal reconstruction. Follow-up was 1 to 17 years (average, 6 years). CONCLUSION: The radial forearm flap infolding technique is the authors' method of choice for microvascular reconstruction of the nose because it allows placement of a primary dorsal cartilage graft for optimal vascularization, and uses the excess dorsal skin during forehead resurfacing to modify the lining inset and shape the nostrils. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Antebraço/cirurgia , Doenças Nasais/cirurgia , Rinoplastia/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/lesões , Neoplasias Nasais/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto Jovem
8.
Plast Reconstr Surg ; 139(1): 30-39, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28027223

RESUMO

BACKGROUND: Since the introduction of nipple-sparing mastectomy as an oncologically safe procedure for the treatment of breast cancer, reconstructive efforts for immediate staged expander/implant reconstruction have focused on submuscular implantation with or without acellular dermal matrix. Suprapectoral reconstruction without acellular dermal matrix has received little attention in the reconstructive literature of nipple-sparing mastectomy. METHODS: Between 2005 and 2015, 155 patients (250 breasts) underwent nipple-sparing mastectomy with prepectoral staged expander/implant reconstruction using thick mastectomy skin flaps without acellular dermal matrix. Patients with different breast sizes, including those patients with very large breasts who required a primary mastopexy, were considered candidates for the suprapectoral reconstruction. Tumor-related data, comorbidities, and preoperative or postoperative radiation therapy were evaluated for correlation with the final outcome. RESULTS: Patients were followed up for an average of 55.5 months (range, 138.1 to 23.6 months). The tumor recurrence rate was 2.6 percent. Adverse outcomes such as capsular contracture, implant dystopia, and rippling were studied. Aesthetic outcome, based on a three-point evaluation scale, showed 53.6 percent of patients as having a very good result, 31.6 percent showing a good result, 9 percent showing a fair result, and 5.8 percent showing a poor result. CONCLUSIONS: The suprapectoral two-stage expander/implant reconstruction without acellular dermal matrix in nipple-sparing mastectomy has certain advantages with respect to breast shape, less morbidity related to expansion, ease of reconstruction, and cost effectiveness. These advantages have to be weighed against those of subpectoral reconstruction with acellular dermal matrix to determine the method of choice. CLINCAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Derme Acelular , Implante Mamário/métodos , Mastectomia Subcutânea , Expansão de Tecido/métodos , Adulto , Implante Mamário/instrumentação , Implantes de Mama , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias , Estudos Prospectivos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos
9.
Plast Reconstr Surg ; 134(5): 1045-1056, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25347637

RESUMO

BACKGROUND: Nasal membranes may be injured by immune disease, infection, trauma, or cocaine. Destruction of the septum, vault and floor lining, external skin, upper lip, and adjacent structures follows. METHODS: Lining injuries caused by cocaine, Wegener granulomatosis, primary syphilis, leishmaniasis, septorhinoplasty, septal cancer excision and irradiation, corrosive inhalation, and foreign body and iatrogenic intubation injury were reviewed. The site and degree of injury were correlated with presentation and anatomical and functional abnormality. RESULTS: Damage may be isolated to the septum, creating a septal fistula with loss of dorsal and tip support and modest collapse of the dorsum and tip with columellar retraction, or the injury may extend onto the vaults and floor, leading to circumferential scar contracture and severe nasal shortening and lip retraction. Progressive disease, infection, or iatrogenic injury increases soft-tissue damage, causing external skin contraction or full-thickness necrosis. CONCLUSIONS: Repair is determined by site, depth of injury, and clinical deformity--not cause. Lining necrosis and subsequent scar contraction, rather than structural compromise of the septum, are the primary causes of the severe deformity. If vault and floor lining injury is minimal, central support alone will restore dorsal and tip projection. Extensive loss requires release of scar contracture and replacement of the vault and floor lining with composite grafts, a microvascular flap, or hinge-over lining flaps, depending on the site and extent of injury. If the external skin is destroyed by scar or a full-thickness loss, a staged forehead flap will be required to resurface the nose.


Assuntos
Mucosa Nasal/lesões , Deformidades Adquiridas Nasais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Rinoplastia/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Transtornos Relacionados ao Uso de Cocaína/complicações , Feminino , Seguimentos , Humanos , Masculino , Mucosa Nasal/patologia , Mucosa Nasal/cirurgia , Septo Nasal/lesões , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/induzido quimicamente , Medição de Risco , Índice de Gravidade de Doença , Retalhos Cirúrgicos/transplante , Resultado do Tratamento
10.
Plast Reconstr Surg ; 132(5): 700e-708e, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24165622

RESUMO

BACKGROUND: Different approaches have been advocated for performing nipple-areola-sparing mastectomy. The inframammary approach has been viewed as having limited applications, particularly in large breasts. The authors review their experience with nipple-areola-sparing mastectomy using the inframammary approach for different breast sizes. METHODS: Between 2005 and 2012, 118 nipple-areola-sparing mastectomies with staged implant-based reconstruction were performed in 80 consecutive patients. Patients with different breast sizes underwent inframammary nipple-areola-sparing mastectomy, except those patients who had very large breasts or those who requested a breast lift. Oncologic data related to tumor size, selection criteria, and recurrences are presented. All nipple-areola-sparing mastectomies and reconstructions were performed by the same surgeons (J.K.H. and A.H.S), who operated as a team in performing the mastectomies. RESULTS: Patients were followed up from 6 to 97 months (mean, 33.5 months). There were four recurrences (5 percent), three of which were attributed to the biological behavior of the tumor. The aesthetic outcomes of the reconstructions were analyzed based on nipple location, breast contour, and symmetry: 35 patients (44 percent) had a very good result, 28 (35 percent) had a good result, nine (11 percent) had a fair result, and eight (10 percent) had a poor result. Risk factors and complications affecting the final aesthetic outcome are discussed. CONCLUSIONS: The inframammary approach for nipple-areola-sparing mastectomy is the authors' procedure of choice for small, medium, and large breasts. The team approach to the mastectomy facilitates the procedure, reduces skin-related complications, and results in a better aesthetic outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Mama/cirurgia , Mastectomia Subcutânea/métodos , Mamilos/cirurgia , Adulto , Idoso , Mama/patologia , Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão
11.
Plast Reconstr Surg ; 127(2): 637-651, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21285769

RESUMO

BACKGROUND: The site, size, and depth of tissue loss, irradiation, or composite injury to adjacent cheek and lip may make local tissues inadequate or unavailable for the repair of major nasal defects. METHODS: In 13 patients, a single, folded, horizontal radial forearm flap was used to line the vault and columella, with an incontinuity fasciocutaneous extension to resurface the nasal floor, with or without primary dorsal support. Later, excess external forearm skin was turned over to adjust the nostril margin and alar base positions. Delayed primary cartilage grafts completed subunit support. A three-stage full-thickness forehead flap provided covering skin. Three-dimensional contouring of the midlayer framework was performed over the entire nasal surface, during an intermediate operation, before pedicle division. RESULTS: Good to excellent aesthetic and functional results were obtained in total and subtotal defects in five operations over 8 months, including a late revision. Partial necrosis of the folded columellar lining (n = 2) and dehiscence of unilateral alar lining (n = 1) were salvaged at forehead flap transfer by hinging over excess external forearm skin (n = 2) or by folding the extension of the forehead flap for columellar lining (n = 1). Indolent cartilage infection necessitated débridement (n = 4) and partial support replacement (n = 3). No free flaps were lost or required to salvage a complication. CONCLUSIONS: The approach is reliable, efficient, and applicable to varied defects and has the ability to correct design errors and complications before pedicle division. An unscarred lining sleeve, defined three-dimensional contour, and thin conforming skin cover are restored.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Nasais/cirurgia , Nariz/lesões , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Cartilagem/transplante , Criança , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Neoplasias das Glândulas Sudoríparas/radioterapia , Neoplasias das Glândulas Sudoríparas/cirurgia , Expansão de Tecido , Adulto Jovem
12.
Ann Plast Surg ; 52(1): 31-5, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14676696

RESUMO

This study compared the combined iliac and ulnar forearm flaps with the osteomusculocutaneous fibular free flap for mandibular reconstruction. A retrospective study of 40 patients who had oromandibular reconstruction was performed, of whom 23 patients had a combined iliac crest without skin and ulnar forearm free flap. Seventeen patients had an osteomusculocutaneous free fibular flap. Ten women and 30 men with a mean age of 57.5 years comprised this study population. Ninety percent of the cases were squamous cell carcinoma (55%, T4), of which 11% were recurrent tumors. Anterolateral mandibular defects constituted 52.9% of the fibular reconstructions and 60.9% accounted for the iliac/ulnar reconstructions. The mean bone gaps were 8.79 cm and 8.95 cm respectively. Functional evaluation was based on the University of Washington Questionnaire through phone calls and personal communication. The mean hospital stay was 15.43 days and 10.09 days for the fibular and iliac/ulnar flaps respectively. The facial artery (64.7%) and facial vein (60%) were the main recipient vessels for the fibular reconstructions whereas the external carotid artery (95.6%) and the internal jugular vein (66.7%) were the main recipient vessels for the iliac/ulnar reconstruction. Overall flap survival was 96.8% (100% of fibular flaps and 95.65% of iliac/ulnar flaps). Two flaps were lost in the iliac/ulnar series because of unsalvageable venous thrombosis. Local complications for the iliac/ulnar flaps were 30.4% but were 5.9% for the fibular reconstructions. Function such as speech, swallowing, and chewing were notably better in the fibular than the iliac/ulnar group in 23 of the patients tested. The cosmetic acceptance of 77.8% of the fibular flaps was judged to be excellent and good, whereas 71.4% of the iliac/ulnar flaps were rated good. It appears that within this study population the free osteomusculocutaneous fibular flap had fewer local complications and a higher flap survival rate than the combined iliac/ulnar forearm flaps. Overall functional outcome was also improved. The use of the double flap may be appropriate in massive oromandibular defects, but may be less appropriate in more modest functional reconstructions of mandibular defects.


Assuntos
Transplante Ósseo , Doenças Mandibulares/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Face/irrigação sanguínea , Feminino , Fíbula/transplante , Humanos , Ílio/transplante , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Ulna/transplante
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