Maxillary reconstruction with a double‐barrel osteocutaneous fibular flap and arteriovenous saphenous loop after a globe‐sparing total maxillectomy—A Case Report

Abstract

Maxillary reconstruction using titanium mesh or bone grafts can invite unwanted complications, such as graft resorption, infection, and mesh exposure, especially for patients who require postoperative radiotherapy. Here, we reported a 58-year-old male patient who was diagnosed with maxillary sinus squamous cell carcinoma. The patient received cancer ablation by a globe-sparing total maxillectomy and was immediately reconstructed with a double-barrel osteocutaneous fibular flap to simultaneously restore the alveolar ridge, orbital support, and oro-sinonasal separation. The short pedicle length inherent in the double-barrel design of the fibular flap and the depletion of healthy recipient vessels in the midface after cancer ablation were overcome by creating an arteriovenous saphenous loop in the neck region. Though there was venous congestion on postoperative day 2, the postoperative recovery was uneventful after the revision of the venous anastomoses. During the 6-months follow-up, the outcome was functionally and aesthetically satisfactory. We believe that the double-barrel fibular osteocutaneous flap, which avoids using titanium mesh and bone grafts, may be a viable reconstructive option in cancer patients with globe-sparing total maxillectomy defects, especially for those who require postoperative radiotherapy. © 2015 Wiley Periodicals, Inc. Microsurgery 37:334-338, 2017.

Double osseous flaps for simultaneous midfacial and mandible reconstruction: Automation in surgical complexity within an entirely computerized workflow

“…Such flap architecture allows for greater mobilization of tissue subunits, allowing to use a single flap to reconstruct composite defects: in this respect, the scapular tip flap was described a versatile technique allowing to reconstruct midfacial defects, providing at the same time a bicortical bone framework suitable for implant placement, as well as a generous muscular cuff, and eventually the possibility to harvest a myocutaneous paddle using the latissimus dorsi (7,8). Other flaps, typically the fibula flap, are not harvested as chimeric flaps, but can be arranged in complex spatial conformations which enable the reconstruction of geometrically complex defects (9).…”

Long‐term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy

“…Free bone grafts, alloplastic materials, tensor fascia lata, pedicle flap, free vascularized flap with or without titanium meshes, hydroxyapatite, polyether ether ketone, or porous high-density polyethylene (Medpor ® ) have all been used for reconstruction. A popular choice is individualized titanium mesh combined with free flap [2][3][4][5][6] ; the titanium mesh provides sturdy support to prevent ophthalmic complications and helps restore midface projection, and the tissue flap is used to cover the mesh, close the wound, and separate the oral and sinonasal cavities. However, complications have been reported.…”