REVASCULARIZED COMPOSITE GRAFTS WITH INSERTED IMPLANTS FOR RECONSTRUCTING THE MAXILLA - IMPROVED FLAP DESIGN AND FLAP PREFABRICATION

Vinzenz K^1,2,3, Holle J², Würinger E², Kulenkampff KJ⁴, Plenk Jr. H⁵, all Vienna, Austria

¹ Dept. for Maxillofacial Surgery, Evangelisches Krankenhaus Wien-Währing (Head: Prim.Univ.-Prof. Dr. K. Vinzenz); ² Dept. for Plastic and Reconstructive Surgery, Wilhelminenspital (Head: Prim.Univ.-Prof. Dr. J. Holle); ³ Institute for Oral and Maxillofacial Surgery, Krankenhaus Lainz (Head: HR Prim. MR. Dr. R. Fischer); ⁴ Central Institute for Radiology, Krankenhaus Lainz (Head: Prim.Univ.-Prof. Dr. H. Czembirek); ⁵ Dept. for Bone and Biomaterials Research, Histological-Embryological Institute (Head: Prof. Dr. Hans Plenk Jr.)

Principal author:

Associate Professor Kurt Vinzenz, M.D., D.D.S.
Dept. for Maxillofacial Surgery
Evangelisches Krankenhaus Wien-Währing
Hans Sachs-Gasse 10-12
A-1180 Vienna
Tel.: +43/1/40422-0, Fax.: +43/1/40565059, Email: kurt.vinzenz@vienna.at

Abstract

A new technique for prefabricating a revascularised composite scapula flap to precisely fit a maxillary defect is presented.

The method is based on careful preoperative planníng, using three-dimensional (3D) reconstructions of CT- data and stereolithographic models. Then a pedicled scapula flap with a split skin graft envelope and inserted endosseous implants is prefabricated and covered by a Goretex^®-membrane. After three to four months these prefabricated grafts are harvested, inserted into the maxillofacial defects, and reanastomosed to the facial vessels. Two to three weeks after successful reconstruction and mucosal healing, dental restoration can be performed with the osseointegrated implants.

This procedure is demonstrated step by step in a case of a 51-year-old female patient with a more than 13-year maxillary defect after resection of a protruding basal meningeoma.

Histological evaluation of an unused marginal part of the flap shows vital bone reactions and attachment of the split skin graft.

Key words: Microvascular reconstruction, maxillofacial defects, prefabricated scapula flap