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PubMed2004

Reconstruction of skull bone defects using the hydroxyapatite cement with calvarial split transplants.

PURPOSE: We sought to present a new method for primary reconstruction of traumatic or tumor calvarial defects. PATIENTS AND METHODS: Forty-one patients underwent reconstruction of calvarial bone defects between October 1998 and December 2001. Among them were 19 patients who needed reconstruction of the calvaria due to traumatic bone loss. Five of these trauma cases had insufficient primary reconstruction of the calvaria. Tumor resection caused calvarial defects in 22 patients. For primary reconstruction of the skull bone defects, calvarial split grafts were used to cover the defect as accurately as possible. The monocortical layers of the calvaria were fixed with titanium miniplates. Irregular defects surrounding the transplanted regions were filled with hydroxyapatite cement. In one case of posttraumatic bone loss, hydroxyapatite cement alone was sufficient to reconstruct the defect. RESULTS: The follow-up of each patient was at least 6 months; the longest period was 38 months. Evaluated clinical and radiologic results are stable, showing no measurable side effects. CONCLUSION: Hydroxyapatite cement alone or in combination with calvarial split grafts gave clinically and aesthetically stable results in the reconstruction of skull bone defects. The cement can be used for many reconstruction possibilities in craniofacial surgery.

Adult↗

PubMed2004

Reconstruction of extensive maxillary defects using zygomaticus implants.

PURPOSE: Maxillary reconstruction after maxillectomy remains a great challenge for the reconstructive oral and maxillofacial surgeon. This article is a clinical retrospective analysis of patients reconstructed with zygomaticus implants after maxillary ablation. PATIENTS AND METHODS: The design of the study was a retrospective review of 9 patients requiring near-total or total maxillectomy for pathologic reasons. Clinical records, photographs, and radiographs were studied. Financial billing statements were reviewed to determine charges for implant reconstruction and method of payment. RESULTS: Maxillary reconstruction using zygomaticus and standard endosseous implants was performed in 9 patients. Maxillary resection was performed for the following reasons: salivary gland malignancy (n = 2), squamous cell carcinoma (n = 5), maxillary mucormycosis (n = 1), and extensive maxillary atrophy and infection secondary to subperiosteal maxillary implant placement (n = 1). A total of 28 zygomaticus implants and 10 standard endosseous implants were used to reconstruct the 9 patients. Six zygomaticus implants and 3 standard endosseous implants failed. The time of zygomaticus implant placement ranged from placement at the time of resection to 3.2 years after the resection. Five patients received radiation therapy. Five patients have been reconstructed with a maxillary obturator and have been functioning with the prosthesis for a minimum of 2 years. CONCLUSION: The combination of zygomaticus and standard endosseous implants can be used to reliably reconstruct patients after extensive resection of the maxilla.

Aged↗

PubMed2005

Spectral signal-to-noise ratio and resolution assessment of 3D reconstructions.

Measuring the quality of three-dimensional (3D) reconstructed biological macromolecules by transmission electron microscopy is still an open problem. In this article, we extend the applicability of the spectral signal-to-noise ratio (SSNR) to the evaluation of 3D volumes reconstructed with any reconstruction algorithm. The basis of the method is to measure the consistency between the data and a corresponding set of reprojections computed for the reconstructed 3D map. The idiosyncrasies of the reconstruction algorithm are taken explicitly into account by performing a noise-only reconstruction. This results in the definition of a 3D SSNR which provides an objective indicator of the quality of the 3D reconstruction. Furthermore, the information to build the SSNR can be used to produce a volumetric SSNR (VSSNR). Our method overcomes the need to divide the data set in two. It also provides a direct measure of the performance of the reconstruction algorithm itself; this latter information is typically not available with the standard resolution methods which are primarily focused on reproducibility alone.

Algorithms↗

PubMed2006

Venous reconstructions in lower limbs associated with resection of malignancies.

BACKGROUND: Patients with tumors in the limbs who undergo surgical treatment may have involvement of major vessels. Major arteries are always reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension signs and symptoms. The objective of this study was to analyze the results from surgical treatment of a sample of patients who underwent lower limb venous reconstructions associated with the resection of malignant tumors. METHODS: Follow-up was performed of 17 patients with malignant tumors involving major vessels in the lower limbs. The median length of follow-up was 22 months. Venous reconstruction concomitant to arterial reconstruction was performed in 15 patients, and an isolated venous reconstruction was performed in 2 patients. The venous substitutes used were the contralateral long saphenous vein (n = 12), expanded polytetrafluoroethylene prosthesis (n = 3), and Dacron prosthesis (n = 2). RESULTS: Vascular complications occurred in seven patients: three occlusions of the venous graft, edema in seven patients, and one rupture of the arterial graft. The primary 2- and 5-year patency rates of venous reconstructions were 79.3% and 79.3%, respectively. Nonvascular complications occurred in six patients: neurological deficit (n = 3), partial necrosis of the flap (n = 2), wound infection (n = 1), hematoma (n = 1), and enteric fistula (n = 1). Eight patients were still alive and disease free, although one of them underwent above-knee amputation as a result of local disease recurrence. One patient experienced regional disease recurrence and is undergoing chemotherapy. Eight patients died due to pulmonary metastases. The 2- and 5-year overall survival rates were 58.6% and 42.4%, respectively. The 2- and 5-year thrombosis-free survival rates were 51.9% and 35.2%, respectively. CONCLUSIONS: Lower limb venous reconstructions associated with tumor resection in this study gave good functional results, although the prognosis for these patients had been unfavorable. The saphenous vein is a suitable substitute.

Adolescent↗

PubMed2005

Comparison of 2-dimensional magnetic resonance imaging and 3-planar reconstruction methods for targeting the subthalamic nucleus in Parkinson disease.

OBJECTIVE: The study aims to compare 2-dimensional (2D) and 3-planar (3P) reconstruction magnetic resonance imaging (MRI) methods of targeting the optimal region of the subthalamic nucleus (STN) for chronic stimulation in patients with Parkinson disease. METHODS: We studied 14 patients with Parkinson disease treated with bilateral STN deep brain stimulation (DBS) (28 STN targets). Electrode implantation was based on direct and indirect targeting based upon the position of the anterior and posterior commissures using 2D MRI, with selection of the final target based on microelectrode recording. Optimal settings, including the contacts used, were determined during the clinical follow-up. The position of the best contact was defined with postoperative MRI. Optimal contact position was compared to targets calculated by the direct method from the preoperative 2D MRI and 3P reconstruction. Optimal contact position was also compared to the indirect targets calculated from the preoperative 2D MRI and 3P reconstruction. The distance between the targets and the position of the best contact were calculated. RESULTS: The mean improvement in OFF-period Unified Parkinson Disease Rating Scale III subscores with STN DBS was 52%. The mean distance between the optimal contact position and the direct target was 4.66 mm (SD = 1.33) using the 2D MRI and 3.49 mm (SD = 1.29) using the 3P reconstruction (t test, P < .001). The mean distance between the optimal contact and the indirect target was 3.42 mm (SD = 1.34) using the 2D MRI and 2.61 mm (SD = 0.97; t test, P = .001) using the 3P reconstruction. The variance of the direct target was less using the 3P reconstruction than using the 2D MRI (F test, P = .002), indicating greater precision. Similarly, the variance of the indirect target using the 3P reconstruction was less than using the 2D MRI (F test, P = .012). CONCLUSION: Indirect and direct targets chosen using 3P reconstruction more closely approximate the position of the clinically optimal contact than targets chosen using 2D MRI.

Deep Brain Stimulation↗

PubMed2007

Radial forearm free flap for reconstruction of the oral cavity: clinical experience in 55 cases.

OBJECTIVE: Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection. STUDY DESIGN: During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site. RESULTS: Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia. CONCLUSION: Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.

Adolescent↗

PubMed2005

Robustness of reconstructing the Young's modulus distribution of vulnerable atherosclerotic plaques using a parametric plaque model.

Assessment of atherosclerotic plaque composition is crucial for quantitative monitoring of atherosclerosis and for quantifying the effect of pharmaceutical plaque-stabilizing treatments during clinical trials. We assessed this composition by applying a geometrically constrained, iterative inverse solution method to reconstruct a modulus elastogram (i.e., Young's modulus image) from a plaque strain elastogram (i.e., radial strain image) that is measured using intravascular ultrasound strain elastography. This reconstruction method is especially suited for thin-cap fibroatheromas (TCFAs) (i.e., plaques with a thin fibrous cap overlaying a lipid pool). Because a strain elastogram of a plaque depends upon the plaque material composition, catheter position within the vessel and measurement noise, this paper investigates how robust the reconstruction is when these parameters are varied. To this end, a standard plaque was defined as the modulus elastogram that was reconstructed from an in vivo measured strain elastogram of a human coronary plaque. This standard plaque was used to computer-simulate different strain elastograms, by varying the 1. geometry and material properties of its plaque components, 2. catheter position and 3. level of added strain noise. Robustness was evaluated by quantifying the correctly reconstructed size, shape and Young's modulus of each plaque component region and minimal cap thickness. The simulations showed that TCFAs can be adequately reconstructed; the thinner and stiffer the cap or the softer and larger the lipid pool, the better is the reconstruction of these components and minimal cap thickness. Furthermore, reconstructions were 1. independent of catheter position and 2. independent of strain noise. As such, this method has potential to monitor robustly and quantitatively atherosclerosis in vivo.

Algorithms↗

PubMed2002

Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy.

BACKGROUND: Immediate breast reconstruction is often performed after mastectomy for breast cancer. There has been concern that this will result in a delay in initiating chemotherapy and, as a consequence, may adversely impact survival. In this study we sought to determine whether immediate breast reconstruction affects the interval between surgery and adjuvant chemotherapy. METHODS: A single institution retrospective analysis was made using the institutional tumor registry and chart reviews. RESULTS: Forty-nine patients were identified who had undergone mastectomy with immediate reconstruction followed by adjuvant chemotherapy. They were compared with 308 patients undergoing mastectomy without reconstruction. Patients who underwent reconstruction were overall younger (46 versus 55, P <0.001), and had more advanced disease. The time to chemotherapy was significantly longer in the group receiving no reconstruction: 53 versus 41 days (P = 0.039). The type of reconstruction did not affect the time to chemotherapy. CONCLUSIONS: Immediate reconstruction after mastectomy does not increase the time to chemotherapy compared with mastectomy alone.

Abdominal Muscles↗

PubMed2003

Thumb reconstruction for aesthetic reasons using an exteriorised microvascular pedicle.

Thumb reconstruction following amputation is usually performed in order to restore function. Nevertheless, the reconstruction should be cosmetically acceptable in order to be fully functional, and, in some cases, reconstructive surgery may be justified for purely aesthetic reasons. The most satisfying aesthetic results in adults are obtained with microsurgical partial great-toe transfer. The technique that we use for thumb reconstruction is illustrated by two case reports: that of a 26-year-old female patient and that of a 35-year-old male patient. Both patients had a distal thumb amputation with destroyed nail apparatus, and both sought thumb reconstruction for cosmetic reasons. Aesthetic reconstruction was performed in both cases with a partial ipsilateral great-toe transfer, composed of nail apparatus, underlying bone and custom-made pulp tissue. The vascular anastomosis was done at the snuff-box, through a small incision, with an exteriorised pedicle. The result was satisfactory in both cases, with minimal donor-site sequelae. Partial toe transfer has proven to be a reliable technique for thumb reconstruction. It is an evolving technique. Many modifications have been introduced to optimise the aesthetic result and to reduce donor-site morbidity. Our technique allows us to restore thumb length, replace the missing nail and reconstruct the pulp, with acceptable sequelae at the donor toe. The exteriorised-pedicle technique prevents pedicle compression and twisting and reduces scarring and stiffness. It does, however, require delicate postoperative care and a second procedure for pedicle division.

Adult↗

PubMed1998

Multiplanar reformatting and three-dimensional reconstruction: for pre-operative assessment of the thoracic aorta by computed tomography.

INTRODUCTION: Conventional CT demonstrates pathology of the thoracic aorta. This study aimed to evaluate the additional contributions to surgical planning of multiplanar reformatting, maximum intensity projections and three-dimensional (3-D) reconstruction. DESIGN: Retrospective. SUBJECT AND METHODOLOGY: Fifty-three patients with newly diagnosed pathology of the thoracic aorta were scanned over a 15-month period; 25 scans were spiral acquisitions. Scans were acquired during and following rapid injection of 100 ml of intravenous iopromide. The reconstructed data was displayed as axial images, oblique or other multiplanar reformats and shaded surface display 3-D reconstructions. Two radiologists and two surgeons reviewed the images. The axial images were assessed initially, subsequently the reformats and 3-D reconstructed views were examined looking particularly for additional information that might add to the surgical management. RESULTS: Pathologies encountered were aortic dissection (21 patients, including two with Marfan's syndrome), saccular aneurysms (eight), fusiform aneurysms (16), aortic root and ascending aortic dilatation (seven) and coarctation (one). The relationship of aneurysms and dissections to major vessels are better shown with 3-D reconstruction or oblique reformats. Morphology of saccular aneurysms, particularly the neck, is well shown with 3-D reconstruction. Coarctation was best demonstrated by oblique reformats. There was little additional information from 3-D reconstruction or reformats in assessment of type A dissection. Improved spatial orientation by visualization in varying projections was helpful for surgical planning in certain cases of type B dissection, fusiform aneurysms and aortic root and ascending aortic root dilatation. Spiral acquisitions have the advantage of speed and hence a greater anatomical coverage for a single breath-hold. CONCLUSION: Oblique reformats and 3-D reconstruction, although using identical data as the axial images, in specific cases were felt to aid surgical assessment of aneurysms and dissections, thus assisting pre-operative planning.

Aortic Dissection↗

PubMed2002

Peripheral nerve reconstruction by autograft.

The purpose of this retrospective clinical study was to present the results achieved by microsurgical reconstruction of peripheral nerve injuries in the 15 years between 1985 and 1999. Sixty patients underwent 63 surgical procedures. Forty-five nerves were reconstructed by autograft in 42 patients with injuries of the upper extremities; 14 patients had lower limb peripheral nerve reconstruction. The facial nerve was reconstructed by autograft in four patients. Factors that could possibly affect the results, such as delaying surgery, age of the patient, nature of the injury, length of the autograft, height of the injury and type of nerve damage, were assessed. The results were better in the reconstruction of nerve injuries in the upper than the lower limbs. Reconstruction of the tibial nerve was also rewarding. In general, the results of facial nerve reconstruction were good. The time between injury and reconstructive surgery was a crucial factor for successful outcome, especially in younger patients.

Adult↗

PubMed2000

Radical retropubic prostatectomy: bladder neck preservation versus reconstruction.

PURPOSE: We compare bladder neck contracture, urinary continence and positive surgical margin rates after bladder neck preservation and excision with radical retropubic prostatectomy. MATERIALS AND METHODS: A retrospective analysis of clinical and pathological findings, and followup of 220 patients who underwent radical retropubic prostatectomy was performed. Patients were divided into 3 groups of bladder neck preservation (101), "tennis racket" reconstruction (63) and anterior bladder tube reconstruction (56). RESULTS: Mean followup was 19.7, 36.7 and 16.2 months, respectively, for bladder neck preservation, tennis racket reconstruction and anterior bladder tube reconstruction. Overall, bladder neck contracture occurred in 22 of 220 cases (10%), including 5 of 101 (5%) with bladder neck preservation, 7 of 63 (11%) with tennis racket reconstruction and 10 of 56 (18%) with anterior bladder tube reconstruction, which approached statistical significance (p = 0.061). Urinary continence was assessed by a third party telephone interview of 165 patients. Continence rates at 1 year were 93% for bladder neck preservation, 96% for tennis racket reconstruction and 97% for anterior bladder tube reconstruction, which was not statistically significant (p = 0.68). Positive margin rates were 27.4% with bladder neck preservation versus 30.5% with excision, which was not significantly different. CONCLUSIONS: There are no statistically significant differences in return of urinary continence, bladder neck contracture rates or positive margins between bladder neck preservation and excision.

Adult↗

PubMed1990

Reconstruction after mastectomy.

Advances in materials and techniques, especially those involving transposition of muscle and skin flaps, have made breast reconstruction possible for most women who undergo mastectomy for breast cancer. The availability of this option can alleviate the breast and chest wall deformity that results from virtually all local treatment of breast cancer. It is essential that the reconstruction surgeon be part of the breast cancer management team from the beginning of treatment planning and that this surgeon work closely with the general surgeon, medical oncologist, and radiation therapist as well as the adjunctive treatment team members. The patient's clinical status and the type of local treatment will be significant determinants of the reconstructive options. For women with stage I breast cancer, these decisions may be based largely on the oncologist's local and adjunctive therapy procedures and the woman's desire to proceed or delay. For women with systemic disease, all members of the breast management team may need to agree on the advisability and timing of reconstruction. Central to all of the numerous decisions described in this paper regarding the timing, type, and extent of breast reconstruction is the primary goal of the entire team: the best possible management of the breast cancer itself. The promise of attractive, symmetric, and natural appearing breasts, complete with a symmetric nipple-areolar complex, has eased somewhat the diminishment of self-esteem and the threat to femininity that can accompany the loss of a breast. By lowering fear, the widely recognized availability of breast reconstruction may encourage more women to monitor their breasts and seek diagnosis of changes and may influence selection of the type of local treatment if cancer is detected. Because of the psychological and cultural significance of the breast, the reconstructive surgeon must be particularly sensitive to the psychological and aesthetic expectations of the patient. Even in those patients with metastases and limited life expectancy, breast reconstruction can enhance the quality of life.

Breast↗

PubMed2002

Development of bovine oocytes reconstructed with different donor somatic cells with or without serum starvation.

We conducted this study to examine whether serum starvation in culture contributes to better development of bovine reconstructed oocytes and to evaluate which serum-starved somatic cell is the most effective for cloned calf production. In Experiment 1, donor cells of four different types (cumulus cells, ear fibroblasts, oviduct cells and uterine cells) were either serum-starved or not before fusion with enucleated oocytes, and reconstructed oocytes were further cultured for 168 h. Regardless of serum starvation, cumulus cells or ear fibroblasts yielded higher (P < 0.05) rates of fusion than other cells (62.6-69.3 versus 33.3-38.7%). In the serum-starved group, the first cleavage after reconstruction was significantly increased in cumulus cells and ear fibroblasts, compared with oviduct cells (93.4-94.3 versus 78.8-86.0%), and oocytes reconstructed with either of these yielded more blastocysts than oocytes reconstructed with oviduct or uterine cells (40.6-43.8 versus 20.3-19.0%). We observed a similar pattern in the non-starved group, but we found a significant increase in blastocyst formation was found only in cumulus cells compared with other donor cells (42.6 versus 15.4-27.7%). Overall comparison showed that serum starvation increased the rates of cleavage and development to the blastocyst stage, but we found a statistical significance only in the cleavage rate (80.0 versus 89.5%). In Experiment 2, we transferred randomly selected 59 blastocysts that were developed from oocytes reconstructed with serum-starved cells to 44 synchronised recipients. Of those recipients, 23 became pregnant on Day 60 after transfer (52.3%) and 12 (27.3%) delivered cloned calves. The mean gestation length and birth weight was 275 +/- 8 days and 39.6 +/- 15.6 kg, respectively. Although there was no significant difference among donor cells, blastocysts that were derived from oocytes reconstructed with ear fibroblasts yielded the highest rates of pregnancy (50.0%) and delivery (27.3%). In conclusion, serum starvation is effective for improving preimplantation development of oocytes reconstructed with cumulus or ear fibroblast cells and it may positively influence on obtaining better pregnancy outcome.

Animals↗

PubMedDate not supplied

Cartilage reconstruction of the scutum defects in canal wall up mastoidectomies.

PURPOSE: This study was performed to evaluate whether cartilage reconstruction of scutal wall defects diminishes retraction pocket and recurrent cholesteatoma, as compared with no cartilage reconstruction of the scutal defect. MATERIALS AND METHODS: A retrospective chart review from 1980 to 1993 was performed on all patients undergoing a canal wall up mastoidectomy. These procedures were done in a large teaching hospital where some surgeons reconstructed with cartilage and others did not. The recurrence rate of cholesteatoma and retraction pockets, as well as the need for further surgery, was assessed. RESULTS: There were 103 canal wall up mastoidectomies performed, and 84 patients were available for long term follow-up. Of these, 52 were not reconstructed with cartilage, whereas 32 were reconstructed with cartilage. Of the 52 patients not reconstructed, 47% did not develop retraction pockets. Of the 53% who did develop a retraction pocket, only one third required further surgery, and the others were managed in the office. Of the 32 patients that were reconstructed with cartilage, 66% did not develop further retractions. Of the 34% who did develop a retraction pocket, one third required further surgery. In both groups, those who did require further surgery did have recurrent cholesteatoma as well. CONCLUSION: It would appear that reconstruction of scutal wall defects after canal wall up mastoidectomies with cartilage may be of some benefit in preventing further retraction pockets and thus the recurrence of cholesteatoma.

Adult↗

PubMedDate not supplied

Latissimus dorsi myocutaneous flap for secondary head and neck reconstruction.

PURPOSE: To review our experience and results with the use of pedicled latissimus dorsi myocutaneous flap (LDMF) for secondary reconstruction in head and neck surgery. METHODS: Twenty-two patients had LDMF, 17 of them for secondary reconstruction. Data were collected regarding the primary surgery, primary method of reconstruction, indication for secondary reconstruction, and outcome. RESULTS: Seventeen LDMF procedures were performed for secondary reconstruction. Flap success rate was 100%. Reconstructive goals were achieved immediately in 16 (94.1%) patients. CONCLUSION: LDMF is a thin flap with a large surface area and a long pedicle that allows it to reach any region in the head, neck, and scalp. Its main disadvantages are the need for lateral positioning of the patient and the fact that its pedicle is not protected with muscle. In our experience, LDMF provides an excellent reconstructive option especially in complicated cases of secondary reconstruction. It may be used in cases where a free flap is usually used, but with significantly reduced surgical time.

Adult↗

PubMed1997

A regional approach to reconstruction of the upper lip.

PURPOSE: This articles reviews the results obtained when cheek or lower lip flaps, or a combination of these flaps, are used for the reconstruction of defects of the upper lip. PATIENTS AND METHODS: Twenty-four cases of either partial or total full-thickness defects of the upper lip were reconstructed. Four cases with lateral full-thickness partial defects were reconstructed by advancing a cheek flap using the Bernard-Burow method. In five cases, defects located at the junction of the upper lip and the cheek were reconstructed with an Estlander flap. Four patients with a tight upper lip were corrected with an Abbé flap. In two cases, a modified mucomuscular Abbé flap was used for reconstruction of a vermilion defect of the upper lip. Nine patients with subtotal or total full-thickness defects of the upper lip were reconstructed with a combination of bilateral or unilateral cheek flaps using either the Bernard-Burow or Dieffenback method and T-shaped or oblong Abbé flap. RESULTS: All regional flaps healed uneventfully, and the function of reconstructed upper lips had recovered within 2 years postoperatively. CONCLUSION: Use of regional flaps to reconstruct partial or total full-thickness defects of the upper lip can usually achieve satisfactory functional and esthetic results.

Adolescent↗

PubMed1987

Clinical course and evaluation of shape and function after reconstruction using various pedicle flaps for oral and maxillofacial defects.

In the past 7 years, reconstruction using various pedicle flaps for oral and maxillofacial defects, was carried out for 40 patients. Pectoralis major myocutaneous, deltopectoral and scalp-forehead flaps for large defects, and sternocleidomastoid, cervical island skin and palatal flaps for moderate defects were indicated. As for results, most of the flaps used at the reconstructed site for the defects of soft tissue repaired the shape and patients were satisfied. However, the recovery of functions concerning speech, swallowing or mastication was not always successful with the larger defects, especially after the reconstruction for defects of tongue, floor of the mouth, cheek and mandible for which mandibular reconstruction was performed. It was pointed out that the main causes for less tongue mobility were due to scar contracture after reconstruction, and difficulty of mandibular reconstruction due to postoperative infection were associated factors. Accumulated survival rate of patients for 5 years was 62.6%, in which 38 advanced malignant tumors were reconstructed following surgery. In the clinical course after reconstruction, patients with primary tumors experienced much better results than those with secondary tumors.

Adult↗