Risk factors of fat necrosis in pectoralis major myocutaneous flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the risk factors of fat necrosis in pectoralis major myocutaneous flaps.</p><p><b>METHODS</b>From May 1998 to December 2005, 82 patients underwent reconstruction of oral and maxillofacial defects with pectoralis major myocutaneous flaps in our hospital. Postoperative fat necrosis of the flaps was occurred in 10 cases. Logistic regression analysis was used to investigate the risk factors.</p><p><b>RESULTS</b>(1) Logistic univariate regression analysis indicated that there was a significant correlation between fat necrosis of pectoralis major myocutaneous flap and the following risk facoars: obesity, subcutaneous tissues dissection performed by electrotome, the design of skin island beyond the seventh costal cartilage and smoking. (2) Logistic multivariate regression analysis suggested that there was a significant correlation between fat necrosis of pectoralis major myocutaneous flap and obesity, subcutaneous tissues dissection performed by electrotome, the design of skin island beyond the seventh costal cartilage, whereas there was no significant correlation between fat necrosis of flap and smoking.</p><p><b>CONCLUSIONS</b>Obesity, subcutaneous tissues dissection performed by electrotome and the design of skin island beyond the seventh costal cartilage were the risk factors of fat necrosis in pectoralis major myocutaneous flap.</p>

Reconstruction of mandible defect in osteoradionecrosis patients with free fibula osteomyocutaneous flap / 中华显微外科杂志

Objective To explore the clinical applicating and efficacy of free fibula osteomyocutane- ous flap in mandible defect reconstruction in osteoradionecrosis patients.Methods The mandible defects were reconstructed by free fibula flaps with or without muscle cuff.The soft tissue defects were repaired by skin paddles.Status of osteotomy in fibula and flap survival was recorded.The complication in recipient site and donor site,as well as mouth opening and occlusion were reviewed.Facial contour and chewing function after reconstruction were evaluated.Results Patients were followed up 3-16 months.4 free fibula flaps with muscle cuff and 5 without muscle cuff survived well.The size of mandible defects covered from 6cm to 17cm. And the harvested fibula flaps with length of 8.6-17cm were cut into 3 segments in 2 cases,and 2 segments in 5 cases.Fibula flap was divided into 2 segments and overlapped in 2 cases.No serious complication was oh- served in recipient site and donor site.Satisfying esthetic result and normal occlusiong of heath mandible were obtained in all cases.The degree of mouth opening was 2.5-3.3cm.Fair chewing function was revealed in re- constructive region after prosthesia repaired.Conclusion Free fibula osteomyocutaneous flap is relatively ideal reconstruction material of mandible defect in osteoradionecrosis patients for its high survival rate and well esthetic results.

Correction of dento-maxillofacial deformities following cleft lip and palate repair with orthognathic surgery and orthodontics / 中华整形外科杂志

<p><b>OBJECTIVE</b>To restore good occlusion and face profile, the orthognathic operation and orthodontics were used to correct the dento-maxillofacial deformities following the repair of cleft lip and palate.</p><p><b>METHODS</b>21 patients (7 males and 14 females, mean age of 20.6 years) were included in this study. Their dento-maxillofacial deformities following the repair of cleft lip and palate have been corrected in our hospital since 1996. Of them, 17 patients received pre- and postoperative orthodontic treatments. 21 cases underwent the following surgical procedures: Le Fort I osteotomy in 7 cases, multisegmental Le Fort I osteotomy in 5 cases, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) in 4 cases, Le Fort I osteotomy and mandibular body osteotomy in 2 cases, BSSRO and genioplasty in 2 cases, BSSRO in 1 case. Rigid internal fixation was used in all patients. After multisegmental Le Fort I osteotomy, the rigid fixed palatine splint was used for 6 approximately 8 weeks.</p><p><b>RESULTS</b>Osteotomy segments healed well in all cases without severe complications. 14 patients were followed-up for an average of 25.6 months. There was no evident relapse. 12 patients who received pre- and postoperative orthodontic treatments had satisfactory occlusion and face profile.</p><p><b>CONCLUSIONS</b>Orthognathic operation combined with orthodontics can be used satisfactorily to correct the dento-maxillofacial deformities following cleft lip and palate repair.</p>

Maxilla reconstruction with the free iliac osteomuscular flap and simultaneous osseointegrated implant embeding / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of reconstruction of maxillary defects with vascularized iliac crest flap and simultaneous osseointegrated implant embedding.</p><p><b>METHODS</b>During September to October 2003, two patients with maxillary defects from tumor resection underwent microsurgical reconstruction. The free iliac osteomuscular flap transferring and simultaneous osseointegrated implant embedding were performed to repair the defects. Three months after the reconstructive surgery, an abutment operation was preformed and denture was applied in both cases.</p><p><b>RESULTS</b>The flaps survived well. Postoperative follow-up for 8 to 9 months showed that the patients obtained good zygomaxillary appearance, normal occlusion, and satisfactory pronunciation, without oronasal fistula or other serious complications.</p><p><b>CONCLUSIONS</b>The free iliac crest osteomuscular flap with simultaneous osseointegrated implant embedding is an ideal, effective and cosmetically acceptable method for maxilla reconstruction.</p>