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1. Recreating the primary defect
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Not a familiar procedure to the reconstructive surgeon, additional help may be sought. Plan and outcome is based on obtaining true defect |
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2. Loss of tissue plane
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Results from surgery and radiation. Extreme caution is exercised to avoid injury to underlying vessels |
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3. Soft-tissue contraction
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Seen when no or soft tissue alone was used without splinting the mandible. The defect needs more tissue than anticipated |
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4. Measuring a true bone gap
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Mandible requires trimming on edges and avoiding previous fixation points |
| 5. Choice of suitable recipient vessels |
Should be the first step and often contralateral neck is explored. Planning the orientation of the flap is based on site of anastomosis and pedicle length |
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6. Absence of condyle
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Soft-tissue pocket at glenoid helps support ascending part of neomandible. Anchoring may be used |
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7. Re
establishing contour and occlusion
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Use of previous reconstruction plate or CT-guided 3D printing templates |
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8. Non
pliable skin and hypovascularity
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Watch for skin necrosis at the most distal ends and chin. Additional skin or secondary closure is option |
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9. Neck defect closure
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Loose approximation avoids pressure and allows drainage |
| 10. Measure of success |
Goals are similar to primary but in reality limited to survival of the flap and amelioration of symptoms |
