Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
O.237 Donor site morbidity after microvascular ﬁbula transfer C. Taner, Hc. Jacobsen, P. Sieg. Department of Maxillo-Facial Surgery, University of Luebeck, Luebeck, Germany Background: In a sixteen-year period, 165 reconstructions were performed using the lateral calf as donor region for microvascular tissue transfer. Fibula bone was used for reconstruction of the mandible/maxilla and was harvested alone or including skin paddle and/or Flexor hallucis longus muscle for soft tissue reconstruction. The aim of this study is to evaluate the donor site morbidity respective of the time interval after the transfer and the kind of transferred tissue as well as to ﬁgure out technical errors causing functional impairment in the donor region. Methods: 61 donor regions in 55 patients were included to our study up to now. A nonrandomized retrospective analysis is being carried out not only taking the individual risk factors of any patient and a detailed analysis of the toe-function into consideration but also using the Kitaoka ankle-hindfoot score. Being developed by the American Orthopedic Foot and Ankle Society the Kitaoka ankle-hindfoot score incorporates subjective and objective factors into numerical scales to describe function, alignment and pain. Results: The average ankle-hindfoot score was 87 (maximum possible 100) and ranged between 14 and 100 with 65% excellent and 18% good results. 35% of patients suffer from mild dysesthesia in the superior ﬁbula nerve. In 27.8% we found deﬁcits in dorsal extension of the hallux. Contrary to our expectations also claw toe deformities were discovered in 27.8% of the operated leg. Gait abnormalities have been found in 14.5% so far and ankle joint instability due to ﬁbula transfer has been seen in 6.5% of the examined patients. Conclusion: In general, the patient perception of donor site morbidity was low. Although in a few cases the donor site morbidity has to be considered as severe, in the vast majority of cases no long-lasting functional impairment resulted after free microvascular ﬁbula transfer, still the patients need to know about all possible complications. A detailed analysis of the results will be given in the oral presentation. O.238 Donor site morbidity after ulnar forearm ﬂap harvest M. Dericioglu, Hc. Jacobsen, P. Sieg. Maxillofacial Surgery, Medical University of Luebeck, Luebeck, Germany Objectives: In order to consider the pros and cons of the use of microvascular ulnar forearm ﬂap the aim of our study was to evaluate the functional long-term outcome in the donor site following ulnar forearm ﬂap harvest. Methods: From May 1994 to January 2008 a total of 174 patients underwent ulnar forearm ﬂap reconstruction for head and neck defects. Up to now 61 patients could be reevaluated for donor site morbidity 3 to 175 months after ﬂap harvest. Functional evaluation included the measurement of grip strength in both hands with the dynamometer, the pressure and vibratory thresholds on the palms of both forearms/hands using Semmes–Weinstein monoﬁlaments (Smith and Nephew Rolyan). The hydration level of the skin surface was determined using a Corneometer (skin hydration measurement device) to reveal a possible impairment of the sympathetic innervation of the hand. The standardised DASH-questionnaire was used for a detailed evaluation of the hand function, also the subjective assessment of the aesthetic outcome was revealed by using an individual questionnaire. Results: The grip strength in the operated forearm was decreased to a small extend in 29.5% of patients. Two of our patients (3.2%) developed a functional problem of the donor hand which was manifest as a clawhand, accompanied by a dry skin surface. Abnormal sensation or numbness in the ulnar site of the donor
Abstracts, EACMFS XIX Congress hands/forearms occurred in 2 cases (3.2%). No difference in the functional outcome was detectable between patients where the donor defect was covered by a full thickness skin graft compared to direct approximation of the wound edges. In the subjective assessment, 75.4% of patients rated the aesthetic outcome at the donor site as acceptable. No patient expressed the wish for corrective or aesthetic surgery. Conclusion: The ulnar forearm ﬂap is a safe and reliable option for head and neck reconstruction. In contrast to its radial pendant the donor site is less hairy and more conveniently located as in the daily routine less visible at the medial area of the forearm. Although in about 30% a decrease of the grip strength was detectable, ﬂap harvest resulted very rarely in functional limitation caused by motor or sensory impairment to the hand. The vast majority of patients were satisﬁed with the functional as well as the aesthetic long-term result in the donor region after forearm ﬂap harvest. O.239 Elimination of through defects of the face with ﬁbula ﬂap E. Verbo, A. Nerobeyev, S. Perﬁliev, S. Buthsan, M. Somova. Centre of Cranio-Maxillofacial Surgery, Moscow, Russia Purpose: To achieve optimal anthropometrical and functional capabilities while eliminating combined “through” defects of the lower part of the face. Methods: To make possible the simultaneous closure of external and internal defects in each patient, the skin part of the ﬁbula ﬂap was placed perpendicular to the bony part, 1.5 cm area in the center of the ﬂap was deepidermized. Modelling of the bony part of transplant was carried out on the donor zone, using individually prepared stereolithographic models for cutting and assembling bones. After afﬁxing the bony part of transplant to appropriate parts of the lower jaw, we closed the “through” defect: the upper part of the fascio-cutaneous ﬂap was joined to fragments of the mucose of the oral cavity, and the lower part was extended externally to close soft tissue defect of the chin and submandibular areas. Results: Full acceptance of the transplant was observed in the case of all patients. Anthropometric integration of the restored zone with other parts of the facial skeleton was achieved. Conclusions: Use of the ﬁbula ﬂap with a perpendicularly positioned osteo-cutaneous section can simultaneously achieve the covering of internal and external defects. Preoperational computer projection of the transplant can help to guarantee the anthrometric integration of the restored zone with the other part of the facial skeleton. O.240 Facial reconstruction with mio-fasciocutaneous free ﬂaps P. Gennaro, T.M. Marianetti, P. Priore, A. Anelli, V. Valentini. Maxillo-Facial Surgery Dept, Policlinico Umberto I, “Sapienza” University of Rome, Roma, Italy Objectives: Malformations, traumas and outcome of oncological amputations, may need soft tissue augmentation in head and neck district. Different surgical techniques have been proposed, through the years, for the solution of these defects, such as alloplastics devices, local and free ﬂaps. Authors present their experience in the reconstruction of defects of the middle and upper third of the face with mio-fascio-cutaneous free ﬂap. Methods: In this work, the Authors present the experience of Maxillo-Facial Department of Rome in the use of faciomiocutaneous free ﬂaps, such as: Forearm, Antero-lateral tight, Parascapular, Gracilis and Latissimus Dorsi, in the tratment of soft tissue defects of the middle and upper third of the face. Results: Resuts obtained were satisfactory from functional and aesthetic point of view. No major complications were experienced.