A “no‐touch‐technique” in mandibular reconstruction with reconstruction plate and free flap transfer

Fujiki, Masahide; Sakuraba, Minoru; Miyamoto, Shimpei; Nagamatsu, Shogo; Hayashi, Ryuichi

doi:10.1002/micr.22403

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…MRP has become less frequently performed because its wound complication rate is significantly higher than that of VBG . However, short‐term results of mandibular reconstruction with MRP have greatly improved with recent advances in reconstructive techniques . Also in the present study, no major plate‐related problems requiring plate removal occurred in the short term.…”

Section: Discussionmentioning

confidence: 49%

Mandibular reconstruction in elderly patients

Miyamoto

Higashino

Sakuraba

2018

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 49%

Mandibular reconstruction in elderly patients

Miyamoto

Higashino

Sakuraba

2018

Journal of Surgical Oncology

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“…A recent study from Davies et al 22 demonstrated that optimizing contouring of reconstruction plates to bone reduces the odds of plate exposure. Fujiki et al 23 suggest a “no-touch-technique” for mandibular plates that prevents contamination by saliva and leads to significantly lower rates of plate-related infection and fistula formation. One alternative to the fibula free flap is the lateral scapular border or scapular tip free flap, which allows for more robust soft tissue coverage of hardware compared to the skin and soft tissue of the lower extremity.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?

McBee,

DiLeo,

Keehn

et al. 2024

Ann Otol Rhinol Laryngol

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Purpose: This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. Methods: A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients’ functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer’s exact test, and 2-sample t tests were used to analyze differences among variables. Results: We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects ( P < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P > .99) and late (9% vs 8%, P > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P = .52) and recovery of a 100% oral diet (67% vs 54%, P = .53). Conclusion: Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.

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“…5 Microsurgical free flaps are now considered state of the art in head and neck reconstruction following head and neck cancer surgery. 5,6 Although some adjunctive postoperative wound care has been proposed to prevent postoperative infections, reduce flap complications, and promote wound healing, [7][8][9] determining how to reduce postoperative wound infections and surgical morbidity remains highly challenging for surgeons.…”

Section: Introductionmentioning

confidence: 99%

Immediate Negative Pressure Wound Therapy After Free Flap Transfer for Head and Neck Cancer Surgery

Lin¹,

Liou²,

Lin³

et al. 2018

The Laryngoscope

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Objective: This study aimed to assess the outcomes of administering negative-pressure wound therapy (NPWT) in patients immediately following free flap reconstruction after head and neck cancer surgery and radical neck lymph node dissection. The outcomes were compared with those of patients who received conventional wound care (CWC).Methods: A retrospective analysis was performed for 58 patients with head and neck cancer who underwent free flap reconstruction after tumor ablation and radical neck dissection between February 1, 2016, and October 31, 2016. All reconstructions were performed by the same plastic surgeon. Charts were reviewed for patient demographics, comorbidities, cancer type, operation time, flap type, postoperative drainage volume, complication rates, length of hospital stay, and wound outcomes.Results: No significant difference was observed between patients receiving NPWT and CWC regarding operation time and drainage volume from the vacuum ball. After the application of NPWT, no patients experienced flap failure or developed a wound infection. Significantly fewer patients receiving NPWT developed complications (9.7% vs. 37.0%; P = 0.025) and developed infections (0.0% vs. 14.8%; P = 0.041) compared with those receiving CWC.Conclusion: On the basis of fewer associated complications and infections, this study supports the immediate use of NPWT after free flap reconstruction in patients who have undergone head and neck cancer ablation and radical neck lymph node dissection.

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A “no‐touch‐technique” in mandibular reconstruction with reconstruction plate and free flap transfer

Abstract: The results of our study showed that our no-touch-technique may be a safe and effective procedure for the prevention of perioperative plate-related complications for mandibular reconstruction with an MRP and free flap transfer.

Cited by 6 publications

References 21 publications

Mandibular reconstruction in elderly patients

Mandibular reconstruction in elderly patients

Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?

Immediate Negative Pressure Wound Therapy After Free Flap Transfer for Head and Neck Cancer Surgery

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