Salvatore Battaglia1, Francesco Ricotta1, Vincenzo Maiolo2, Gabriella Savastio2, Federico Contedini3, Riccardo Cipriani3, Barbara Bortolani4, Laura Cercenelli4, Emanuela Marcelli4, Claudio Marchetti1, Achille Tarsitano5. 1. Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy. 2. Radiology Department, (Head Prof. Alessio Giuseppe Morganti), S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Italy. 3. Plastic and Reconstructive Surgery Unit, (Head Dr. Riccardo Cipriani), Policlinico S. Orsola, Bologna, Italy. 4. Department of Experimental, Diagnostic and Specialty Medicine, Bioengineering Laboratory (Head Prof. Emanuela Marcelli), S. Orsola-Malpighi Hospital, University of Bologna, Italy. 5. Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences, (Head Prof. Claudio Marchetti), Alma Mater Studiorum University of Bologna, Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
Abstract
INTRODUCTION: We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery. TECHNICAL REPORT: We applied our protocol to 42 consecutive patients needing mandibular composite reconstruction. All patients were preoperatively studied with a CTA scan to evaluate the fibular pattern of vascularization and the perforator vessels three-dimensional path and position. Computer assisted surgery (CAS) was performed: a skin paddle outlining guide (SPOG) was designed to reproduce the shape and area of the planned soft tissue resection. CTA measurements and in vivo findings were compared. After performing the CTA, we classified the viable perforators in High Perforators, Medium Perforators and Low Perforators. The average diameter of the perforator vessels was 3 mm. The average difference between the measurements performed on the CTA and the intra-operative measures was 1, 4 mm. The SPOG was based on calf proximal and distal diameters. The anatomical fitting of the guide was obtained thanks to two customized flanges that embrace circumferentially the proximal and distal portions of the leg. The SPOG encompassed appropriate skin/leg regions, allowing the surgeon to localise the required perforator vessel. CONCLUSIONS: CTA protocol appears to be a valuable approach to asses and virtually simulate composite mandibular reconstructions. The SPOG seems to be a valuable tool to reproduce intra-operatively the planned soft tissue area to be reconstructed.
INTRODUCTION: We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery. TECHNICAL REPORT: We applied our protocol to 42 consecutive patients needing mandibular composite reconstruction. All patients were preoperatively studied with a CTA scan to evaluate the fibular pattern of vascularization and the perforator vessels three-dimensional path and position. Computer assisted surgery (CAS) was performed: a skin paddle outlining guide (SPOG) was designed to reproduce the shape and area of the planned soft tissue resection. CTA measurements and in vivo findings were compared. After performing the CTA, we classified the viable perforators in High Perforators, Medium Perforators and Low Perforators. The average diameter of the perforator vessels was 3 mm. The average difference between the measurements performed on the CTA and the intra-operative measures was 1, 4 mm. The SPOG was based on calf proximal and distal diameters. The anatomical fitting of the guide was obtained thanks to two customized flanges that embrace circumferentially the proximal and distal portions of the leg. The SPOG encompassed appropriate skin/leg regions, allowing the surgeon to localise the required perforator vessel. CONCLUSIONS: CTA protocol appears to be a valuable approach to asses and virtually simulate composite mandibular reconstructions. The SPOG seems to be a valuable tool to reproduce intra-operatively the planned soft tissue area to be reconstructed.
Authors: Francesco Grecchi; Piero Antonio Zecca; Aldo Macchi; Alessandro Mangano; Federica Riva; Emma Grecchi; Carlo Mangano Journal: Int J Environ Res Public Health Date: 2020-04-14 Impact factor: 3.390