Reconstruction Flashcards
planning phase
first phase in CASS - computer aided surgical simulation
manipulation of CT/CBCT Dicom data
phase after surgery
evaluation phase
- planning
- modeling
- surgical
- evaluation
cons of microvascular free fibula flap
BONE STOCK
approaches to reconstruction
- integrity
- function
- form
- aesthetics more last
major tissues utalized for free tissue grafting
- radial forearms
- scapula
- iliac crest
- fibula *
- lateral thigh
basics of free flaps
aka free tissue transfer
flaps are autogenously “transplanted” tissue
- skin, muscle, fascia, bone
blood supply for free flaps
intrinsic – anatomy native to donor site
requirement for flap viability
- blood comes in and blood comes out
CASS stands for
computer aided surgical simulation
CASS / virtual surgery
typical applications of CASS
top three noted
- three dimensional models for treatment planning
- custom design prosthesis
- replication of segmental anatomic objects for fabrication of surgical reconstructive guides
opportunities for error
- disconnect b/w ablative and reconstructive teams
- fibular osteotomies are ofen eyeballed
- bone to bone contact
- adequate ORTHOGNATHIC relationships
- condylar alignment
- proper placement of fibula in a anterior/ posterior and inferior superior dimensino
the phases of CASS
- planning
- modeling
- surgical
- evaluation
what goes into the planning phase
high resolution CT/CBCT/CTA scan
3D virtual reconstrutios
scanned occlusal records / dental casts if applicable
web meeting
phase 2 is
modeling
- life sized stereolithographic model of native craniofacial skeletn and / or pathology
- cutting guides, reconstruction plating templates, occlusal splints
- working stereolithographic models
evaluation phase
4th
- postoperative CT scans
- overlays, comparisons
“top down” planning?
True – with maxillofacial reconstruction
- planning from occlusal / prosthodontic perspective of top-down
microvascular free fibula flap discovered when
1989– hidalgo first to report on a series of vascularized fibula grafs for mandibular reconstruction
main disadvantage of microvascular free fibula flap is
LACK OF BONE STOCK
- insufficient bone for the reconstruction of both the skeletal base (inferior border of the mandible) and the alveolar ridge
resulting in vertical discrepency between reconstructed and unaffected sides
-lack of vertical height –
pros of microvascular free fibula flap
- long vascular pedicle
- solid/ sizeable bone stock
- reliable blood supply
- distant donor site/ low donor morbidity
- ability to accuratley plan using 3-d sofware
cons of microvascular free fibula flap
- bone stock
- lengthy operation
- complex with many opportunities for error
the main disadvantage of the fibula flap is the insufficient bone for the reconstruction of both the skeletal base (inferior border of mandible) and the alveolar ridge.
microvascular free fibula is ability to carry —-
carry bone, skin, muscle, nd fascia
With an outstanding
length available for harvest, a solid and sizeable bone stock, a reliable blood supply, an allowance for manipulation of the components of the flap while maintaining adequate blood supply, and the ability to carry bone, skin, muscle and fascia, the fibula flap has become one of the most commonly used vascularized osseous and osteocutaneous flaps for reconstruction of defects around the body, especially the mandible
Virtual surgery improves predictability and accuracy?
details
YES because the traditional microvascular free fibula
- free hnd approach
- operator / experience dependent
- prone to inaccuracies, intra-op adjustments, rarely restored
the future in terms of plates
technology enabling pre-milled plates
potential drawbacks of CASS
cost
adaptability
increased preoperative planning time
CASS offers
- list
- optimal preoperative planning
- decreased intra-operative time
- teaching aide
- improves expectations of both patient/ surgeon
- promotes close coordination between ablative/ reconstruction teams
- less invasive procedures??
integrity
alimentary tract
face
neck
intracranial
first aspect / approach to reconstruction
function
second approach to reconstruction
mastication
swallowing
speech
facial expressions
form
3rd approach to reconstruction
- asthetics
