Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Fichter, Andreas M.; Ritschl, Lucas M.; Georg, Rali; Kolk, Andreas; Kesting, Marco; Wolff, Klaus‐Dietrich; Mücke, Thomas

doi:10.1055/s-0038-1667364

Cited by 15 publications

(7 citation statements)

References 25 publications

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“…Fluorescent imaging was quantitatively reported in 15 articles, including 515 patients [ 6 , 7 , 10 , 13 , 17 , 19 , 22 , 23 , 36 , 37 , 46 , 51 , 52 , 53 , 57 ]. The fields of application included free-flap and DIEP flap perfusion, breast reconstruction surgery, and microvascular surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The selected inflow parameters, slope and Tstart, were heterogeneously statistically significant, while the Tmax showed no statistical significance in any region measured [ 46 ]. Fichter et al examined the effect of the number of osteotomies on bone perfusion in free fibula flaps [ 19 ]. The study found a significant difference in the slope with additional osteotomies ( p = 0.034).…”

Section: Resultsmentioning

confidence: 99%

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Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature

Goncalves

Hoven

Schaik

et al. 2021

Life

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(1) Background: Near-infrared fluorescence imaging is a technique capable of assessing tissue perfusion and has been adopted in various fields including plastic surgery, vascular surgery, coronary arterial disease, and gastrointestinal surgery. While the usefulness of this technique has been broadly explored, there is a large variety in the calculation of perfusion parameters. In this systematic review, we aim to provide a detailed overview of current perfusion parameters, and determine the perfusion parameters with the most potential for application in near-infrared fluorescence imaging. (2) Methods: A comprehensive search of the literature was performed in Pubmed, Embase, Medline, and Cochrane Review. We included all clinical studies referencing near-infrared perfusion parameters. (3) Results: A total of 1511 articles were found, of which, 113 were suitable for review, with a final selection of 59 articles. Near-infrared fluorescence imaging parameters are heterogeneous in their correlation to perfusion. Time-related parameters appear superior to absolute intensity parameters in a clinical setting. (4) Conclusions: This literature review demonstrates the variety of parameters selected for the quantification of perfusion in near-infrared fluorescence imaging.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature

Goncalves

Hoven

Schaik

et al. 2021

Life

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“…With the length of the symphysis segment being fixed to about 27 mm and not designed to be adjustable, it was important that this length does not lead to malperfusion. The selected length for the anterior segment was estimated to be a safe segment length with regard to bone perfusion, as similar values have been used by the authors previously and throughout the literature without leading to complications [22][23][24]. Based on this data, the planned fibula free flap reconstruction templates could now be designed and constructed [25].…”

Section: Discussionmentioning

confidence: 95%

Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible

et al. 2020

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Objectives Mandibular reconstruction after segmental mandibulectomy can be challenging without virtual surgical planning and osteotomy guides. The purpose of this study was to analyze anatomic parameters to facilitate the evaluation of ideal fibula wedge osteotomies to reconstruct the neomandibula in a simple and cost-effective manner without the need for preoperative virtual planning. Materials and methods Computed tomography scans were acquired from randomly selected patients, and all images were obtained from routine clinical diagnostics, e.g., tumor staging, or preoperatively before reconstruction. Data was used to calculate stereolithographic models of the mandible for length and angle measurements. Statistical analysis was performed (p < 0.05). Results CT scans of 100 patients were analyzed: 39 were female and 61 were male patients, mean age was 59.08a. The mandibular arch angle proved to be constant with 241.07 ± 2.39°. The outside B-segment length was 80.05 ± 5.16 mm; the anterior S-segment length was 27.69 ± 3.16 mm. The angle of the mandibular arch showed differences in means (p = 0.004) between age groups, but effect was proved low. No relevant statistical significances were detected. Conclusions The development of a mandible reconstruction template tool would benefit the majority of head and neck patients, which is due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a harmonic mandibular arch with up to three fibula segments. Clinical relevance The developed mandible reconstruction template tool can facilitate the fibula wedge osteotomies necessary for reconstruction of an ideal neomandibula providing a novel approach which is simple and cost-effective.

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“…Basilar reconstitution seems to be preferred at alveolar reconstitution [21,22]. Number of fibular osteotomies varies according to the authors, but it is accepted that bone perfusion decreases with number of bone segments [23,24]. Small bone fragments can compromise vascularization.…”

Section: Plos Onementioning

confidence: 99%

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

et al. 2020

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Purpose The gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction. Methods We performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained. Results We did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters. Conclusion The results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides» for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.

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Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Cited by 15 publications

References 25 publications

Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature

Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature

Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction

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