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Official Journal of the Italian Society of Maxillofacial Surgery
Frequency: 3 issues
Online ISSN 1827-1901
Biglioli F., Liviero F., Autelitano L., Brusati R.
Division of Maxillofacial Surgery University of Milan “San Paolo” Hospital, Milan
Aim. Microvascular flaps are today a fundamental reconstruction technique in the field of maxillofacial surgery thanks to their high reliability and the availability of different tissues in terms of quality and quantity.
Methods. The results obtained in 200 micro-surgical reconstruction procedures of the head and face are analysed. Reconstruction followed cancer ablation in 159 cases, and was due to facial paralysis, limited mouth opening, osteoradionecrosis or severe maxillary atrophy in the remaining 41 cases. Flaps used were: fibula (73 cases), fascia-cutaneous component of forearm (75 cases), rectus abdominis muscle (13 cases), latissimus dorsi muscle (28 cases), iliac crest (7 cases), parascapular system (2 cases) omentum (1 case), lateral brachialis (1 case). Postoperative monitoring comprised both clinical examination and Doppler scanning; 48 completely concealed flaps were monitored by Doppler scanning alone.
Results. The success rate was 95.5%. In 14 cases, surgical re-exploration of the flap was required for vascular insufficiency; 78% of these flaps were saved. Neither prior surgical intervention, nor prior irradiation of the surgical field, nor the presence of metabolic diseases negatively influenced the success rate.
Conclusion. The low rates of failure and complications, together with the good results in morphological and functional terms, make microvascular flaps one of the most significant reconstruction methods for the oral and maxillofacial area, in particular for extensive defects.