Microvascular reconstruction and dental rehabilitation of benign severely atrophic jaws and defects of the alveolar ridge: our philosophy in 2019.

We deal regularly with patients who present with severe atrophy of the jaws, compromised soft tissue, or penetrating defects of the alveolar ridge that are not the result of malignant disease. For these patients we use microvascular bony flaps together with dental implants and implant-supported prostheses. The purpose of this retrospective study was to present our current management and the lessons we have learned over a 16-year period while treating 86 patients for these indications with 87 microvascular bone flaps. We used a transoral approach for the anastomosis in 60 flaps, thereby avoiding visible scars, and inserted 281 dental implants to support fixed or removable dental prostheses. Two femoral flaps developed partial necrosis, and seven implants were lost. Eighty-five of the 86 patients were satisfied with the improvement in their orofacial function and aesthetics. Poor oral hygiene, active osteomyelitis, and severe bruxism are absolute contraindications.

Two-stage cementless revision of late total hip arthroplasty infection using a premanufactured spacer.

We observed 44 patients with 2-stage revisions for septic hip prostheses. We used a uniform protocol consisting of the implantation of a preformed spacer (interval 12-26 weeks), specific systemic antibiotic therapies, and cementless total hip arthroplasty at time of reimplantation. The minimum follow-up was 36 months (mean, 67 months; range, 36-120 months). During the spacer period, we observed 4 dislocations and 2 fractures leading to a resection arthroplasty interval before reimplantation in 5 cases. In one patient, reinfection was diagnosed 12 months after reimplantation. The Harris hip score increased from a preoperative mean of 39 to 90 at a mean follow-up of 67 months after reimplantation.