| [PMID]: | 27730644 |
| [Au] Autor: | Modest MC; Moore EJ; Abel KM; Janus JR; Sims JR; Price DL; Olsen KD |
| [Ad] Endereço: | Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A. |
| [Ti] Título: | Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling. |
| [So] Source: | Laryngoscope;127(1):E8-E14, 2017 Jan. |
| [Is] ISSN: | 1531-4995 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | OBJECTIVES/HYPOTHESIS: Discuss current techniques utilizing the scapular tip and subscapular system for free tissue reconstruction of maxillary defects and highlight the impact of medical modeling on these techniques with a case series. STUDY DESIGN: Case review series at an academic hospital of patients undergoing maxillectomy + thoracodorsal scapula composite free flap (TSCF) reconstruction. Three-dimensional (3D) models were used in the last five cases. METHODS: 3D modeling, surgical, functional, and aesthetic outcomes were reviewed. RESULTS: Nine patients underwent TSCF reconstruction for maxillectomy defects (median age = 43 years; range, 19-66 years). Five patients (55%) had a total maxillectomy (TM) ± orbital exenteration, whereas four patients (44%) underwent subtotal palatal maxillectomy. For TM, the contralateral scapula tip was positioned with its natural concavity recreating facial contour. The laterally based vascular pedicle was ideally positioned for facial vessel anastomosis. For subtotal-palatal defect, an ipsilateral flap was harvested, but inset with the convex surface facing superiorly. Once 3D models were available from our anatomic modeling lab, they were used for intraoperative planning of the last five patients. Use of the model intraoperatively improved efficiency and allowed for better contouring/plating of the TSCF. At last follow-up, all patients had good functional outcomes. Aesthetic outcomes were more successful in patients where 3D-modeling was used (100% vs. 50%). There were no flap failures. Median follow-up >1 month was 5.2 months (range, 1-32.7 months). CONCLUSIONS: Reconstruction of maxillectomy defects is complex. Successful aesthetic and functional outcomes are critical to patient satisfaction. The TSCF is a versatile flap. Based on defect type, choosing laterality is crucial for proper vessel orientation and outcomes. The use of internally produced 3D models has helped refine intraoperative contouring and flap inset, leading to more successful outcomes. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:E8-E14, 2017. |
| [Mh] Termos MeSH primário: |
Retalhos de Tecido Biológico
Doenças Maxilares/cirurgia
Modelos Anatômicos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Escápula/transplante
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| [Mh] Termos MeSH secundário: |
Adulto
Idoso
Estética
Feminino
Seres Humanos
Masculino
Doenças Maxilares/diagnóstico por imagem
Neoplasias Maxilares/diagnóstico por imagem
Neoplasias Maxilares/cirurgia
Meia-Idade
Estudos Retrospectivos
Tomografia Computadorizada por Raios X
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE |
| [Em] Mês de entrada: | 1708 |
| [Cu] Atualização por classe: | 170804 |
[Lr] Data última revisão:
| 170804 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 161013 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1002/lary.26351 |
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