Acceptable clinical outcomes and recommended reconstructive strategies of secondary maxillary reconstruction with vascularised fibula osteomyocutaneous flap: a retrospective analysis

Publication date: Available online 14 December 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yi Shen, Jun Li, Andrew Ow, Liang Wang, Ming-ming Lv, Jian Sun
BackgroundTo conduct a retrospective analysis of the clinical outcomes and evaluation of reconstructive strategies of patients who underwent secondary maxillary reconstruction with the vascularised fibula osteomyocutaneous flap (VFOF).MethodsFrom May of 2001 to June of 2014, 34 patients who underwent secondary maxillary reconstruction with VFOF, with or without titanium mesh, were reviewed. The patients were divided into 2 groups of maxillary reconstruction, according to different planning and treatment strategies. In Group 1, pre-surgical planning was achieved using 3-dimensional stereomodelling (n=12, Group 1). In Group 2, virtual surgical planning was done and guided templates produced (n=22, Group 2). The differences in the preoperative planning, intraoperative technique, postoperative complications and long-term results between the 2 groups were analysed. Statistical analysis was performed to determine the differences between the 2 groups and the risk factors for prognosis.ResultsSimilar and accurate secondary maxillary were successfully performed in Group 1 and 2, respectively. Postoperative complications were reported in 8 patients in Group 1 and 11 patients in Group 2. Complications were reported in patients who had undergone radiotherapy. The incidence of postoperative complications in Group 2 were lower than that of Group 1 with the exception of midfacial collapse (P > 0.05). The long-term results of some patients with class 3 defects were not satisfactory because of midfacial collapse and lower eyelid ectropion. Stepwise regression analysis showed radiotherapy to be risk factor for prognosis.ConclusionsThe long-term results of secondary maxillary reconstruction were reported to be acceptable in our study. Radiotherapy was the risk factor for prognosis in secondary maxillary reconstruction. Based on our results, we highly recommend our strategy for secondary maxillary reconstruction. Good functional results could be achieved after accurate restoration of maxillary alveolar ridge with several fibular segments using virtual surgical planning and dental restoration.



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