Vascularized rib for facial reconstruction

Plastic and Reconstructive Surgery
Steven P DavisonBruce Davidson

Abstract

The reconstruction of maxillectomy defects is a complex problem encountered in plastic surgery. Defects can range in size and complexity from small defects requiring only soft tissue to complete maxillectomies requiring large tissue bulk, bone, and one or more skin paddles. The most difficult defects involve the skull base and orbit. The reconstructive surgeon is faced with the challenge of isolating the nasopharynx from the dura and globe while simultaneously restoring the bony framework of the maxilla and orbit to support the soft tissue of the cheek. The authors present a series of six reconstructions using a rectus abdominis muscle flap with associated vascularized rib for reconstruction of complex maxillectomy defects. This flap provides large soft-tissue bulk as well as bony support and a long vascular pedicle. A skin island can be taken with the flap, and the donor-site morbidity is comparable to that seen with a vertical rectus abdominis myocutaneous flap. Six flaps were used in five patients over a 20-month period. All patients had stable support of the orbit at follow-up with adequate soft-tissue coverage, and there were no incidences of visual changes.

References

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Citations

Feb 3, 2009·Plastic and Reconstructive Surgery·Jonathan A Zelken, Steven P Davison
Mar 1, 2013·Plastic and Reconstructive Surgery·Fu-Chan Wei, Joseph H Dayan
Oct 12, 2010·The Lancet Oncology·James S Brown, Richard J Shaw
Jun 9, 2015·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Damien Grinsell, Hannah E Catto-Smith
Jun 28, 2005·Clinics in Plastic Surgery·Stuart ArchibaldAchilleas Thoma
Jul 28, 2016·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Matthew J PotterHenk Giele
Oct 22, 2016·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Eva Meia RüeggBrigitte Pittet-Cuénod
Jul 3, 2008·Plastic and Reconstructive Surgery·Steven P DavisonCatherine A Picken

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