How we fix free flaps to the bone in oral and oropharyngeal reconstructions

Arnež, Zoran Marij; Novati, Federico Cesare; Ramella, Vittorio; Papa, Giovanni; Biasotto, Matteo; Gatto, Annalisa; Bonini, Pierluigi; Tofanelli, Margherita; Tirelli, Gian Carlo

doi:10.1016/j.amjoto.2014.10.022

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…The right incisal tooth, canine, bicuspid, and molar were preserved in the present case and provided sufficient structure for stabilizing the artificial dentures. In such cases, implanting an anchor screw into the bone results in easier flap suspension [7–9, 11] .…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of flap suspension using anchors include simplicity, fewer limitations in positioning, and easier adjustment of thread length for suspension, allowing for easier soft tissue fixation without slackening as well as clinically sufficient strength for fixation of ligaments to tissue [7–9, 11] . This device can be used in the mid-face, even if the anchor is exposed inside the maxillary sinus, enabling anchor placement at any position on the maxilla or zygomatic bone; this versatility allows for optimal anchor positioning to achieve stronger fixation and more efficient suspension.…”

Section: Discussionmentioning

confidence: 99%

“…However, this method has limitations in morphological improvements and cannot prevent flap sagging in cases in which rigid reconstruction of the rectus abdominis muscle flap was not performed. Several studies have reported the effective use of anchors to prevent the sagging of a bulky flap [7–11] .…”

Section: Introductionmentioning

confidence: 99%

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Technique for secondary modification after maxillary resection and reconstruction for soft tissue flap fixation before prosthesis addition: a case report

et al. 2019

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Background The removal of maxillary carcinoma causes various types of tissue defects, which can be corrected by free flap reconstruction. In flap reconstruction after maxillary cancer resection, ensuring prosthesis stability is frequently difficult owing to the flap’s weight. Therefore, a second modification technique is required for improvement of configuration. This case where flap suspension and flap modifying surgery were performed using anchor system for the extensive complete maxillectomy case. Case presentation The patient was a 56-year-old male, who underwent an extensive total maxillectomy and flap reconstruction using the rectus abdominus muscles in May 2005. Postoperatively, due to the difficulties of wearing a maxillary denture, he was transferred to our department with the chief complaint of morphological improvement. The maxillary bone had already been removed from the midline with the rectus abdominus muscle flap sutured directly to the soft palate without oral vestibule, and the flap margin was moving together with the surrounding soft tissue. The flap size was 70 × 50 mm, which was sagging due to its own weight and was in contact with mandibular molars, reducing the volume of the oral cavity without a denture being worn. Flap reduction and lifting the flap were performed under general anesthesia using 3 Mitek anchors implanted in the zygomatic bone, and the anchor suture was placed through the subcutaneous tissue to lift the flap. Postoperatively, the prosthesis was stable. No recurrence of flap sagging or wound infection was seen 3 years after surgery. Conclusions The second modification technique after maxillary cancer resection is useful for ensuring prosthesis stability. This method can be used before prosthesis addition. We could obtain remarkable denture stability by flap suspension using anchor system and a flap-modifying operation for the patient who had undergone maxilloecotomy. The denture was stabilized by using anchors for the elevated flap and flap loss technique and by performing vestibuloplasty for support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Technique for secondary modification after maxillary resection and reconstruction for soft tissue flap fixation before prosthesis addition: a case report

et al. 2019

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“… 9 Prevention of fistulae formation in oncologic oral reconstruction may be attained by use of Mitek mini bone anchors, which can provide secure support to the soft flap and avoid dehiscence. 10 …”

Section: Discussionmentioning

confidence: 99%

Successfully Closing an Acquired Palatal-fistula Using a Turnover Flap from a Previously Transferred Forearm-free-flap

Ashville

Panchal

Rosen

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Summary:Palatal fistula between the oral and nasal cavities occurs in about 20% of palatal repairs after oncologic resection. Although healing by secondary intention may be employed as an initial strategy, persistent nonhealing symptomatic fistula necessitates intervention. Folded free flap used for primary repair of palatectomy defects enables placement of epithelialized tissue on both the oral and nasal cavities. In case of acquired palatal fistula, a turnover flap can be easily created, based on the free margin of the folded forearm free flap to serve as a reconstructive lifeboat.

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“…Ready-to-use anchor is prepackaged with absorbable 2.0 sutures charged in the insertion device. 5 Similar to the suspension wiring technique, 8 we prepared 2 calibrated holes, 2.3-mm wide and 9-mm deep, using the drill bit supplied in the package at 3-and 9-o'clock positions of the receiver pocket. Through these pilot holes, we suggest placing the anchor obliquely across the R/S keeping a 30 angle, thus maximizing the entire bony thickness avoiding anchor overpenetration and dura mater damages.…”

Section: Methodsmentioning

confidence: 99%

Cochlear Implant Surgery: How to Fix Receiver/Stimulator Avoiding Extrusion

et al. 2019

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Cochlear implant (CI) surgery is generally safe and associated with a limited number of complications, among which the extrusion of the receiver/stimulator (R/S) or the electrode misplacement and migration might require a CI re-implantation. The aim of this pilot study is to describe a new technique to firmly fix the R/S using the Mitek suture anchors system (Depuy Mitek Surgical Products, Inc. Raynham, Massachusetts). We tested two different models and in our experience, the web of suture created with this device can improve the stability of the bond of the R/S to the underlying curved bone surface. So, this system resulted in a less laborious manner keeping low the complication rate.

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How we fix free flaps to the bone in oral and oropharyngeal reconstructions

Cited by 9 publications

References 27 publications

Technique for secondary modification after maxillary resection and reconstruction for soft tissue flap fixation before prosthesis addition: a case report

Technique for secondary modification after maxillary resection and reconstruction for soft tissue flap fixation before prosthesis addition: a case report

Successfully Closing an Acquired Palatal-fistula Using a Turnover Flap from a Previously Transferred Forearm-free-flap

Cochlear Implant Surgery: How to Fix Receiver/Stimulator Avoiding Extrusion

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