PMID: 9555995Apr 29, 1998Paper

The radial forearm osteocutaneous "sandwich" free flap for reconstruction of the bilateral subtotal maxillectomy defect

Annals of Plastic Surgery
P G CordeiroR Spiro

Abstract

Complex resections of the maxilla produce a three-dimensional defect that can be difficult to reconstruct using autogenous tissue without utilizing a free tissue transfer. The osteocutaneous flaps that have been described for reconstruction of this area have been the scapula, iliac crest, and fibula, which are often hampered by their bulkiness and less than ideal intraoral lining. The bilateral subtotal maxillectomy defect is particularly difficult to reconstruct because it requires restoration of the bony framework of the midface as well as the restoration of the palatal and nasal lining. We present a new technique for reconstruction of this type of defect using the osteocutaneous radial forearm free flap. Two patients with bilateral subtotal maxillectomy defects, in whom the entire hard palate and maxillary arch were resected, underwent primary reconstruction. The bone from the osteocutaneous flap was osteotomized and contoured to recreate the maxillary arch. The large skin island was folded around the bone, as in a sandwich, and used to replace the palatal and nasal lining. This sandwiched osteocutaneous flap allowed for secure fitting of a dental prosthesis and the future possibility of osteointegrated implants. Long-term s...Continue Reading

Citations

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