Facial bone reconstruction with prefabricated vascularized calvarium flaps in children and young adults: Advantages and long-term results. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Rüegg, Eva Meia; Gniadek, Paul; Modarressi, Ali; Baratti-Mayer, Denise; Pittet-Cuénod, Brigitte
• Is Part Of: Journal of cranio-maxillofacial surgery. Volume 44:Issue 12(2016)
• Page Start: 1880
• Page End: 1888
• Publication Date: 2016-12
• Subjects: Calvarium flap -- Noma -- Face reconstruction -- Bone reconstruction -- Bone flap -- Reconstruction children; Skull -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; Maxilla -- surgery -- Periodicals; Face -- surgery -- Periodicals; Skull -- surgery -- Periodicals; Oral Surgical Procedures -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Periodicals; Surgery, Oral -- Periodicals; Electronic journals; 617.514
• DOI: 10.1016/j.jcms.2016.08.021
• Languages: English
• ISSNs: 1010-5182

Abstract

Abstract: Introduction: Reconstruction of facial bone defects in children is challenging. The use of well-vascularized bone is mandatory to obtain stable lasting results. This study reports our experience of facial bone reconstruction using prefabricated vascularized calvarium flaps. Methods: Retrospective case series of 50 patients who underwent 52 maxillary, malar, and mandibular reconstructions between 1988 and 2014 using prefabricated vascularized calvarium flaps. Forty-nine patients suffered from noma sequels; one patient had craniofacial cleft Tessier 3–11. Surgery consisted of a two-step procedure beginning with flap delay and prelamination with skin grafting on the galea. Flap harvest followed at least 2 weeks later (range, 2–16 weeks), including a full-thickness calvarium fragment, which was set into the facial defect. Results: Early complications concerned wound healing and infections requiring surgical revision in six patients at the recipient and six at the donor site. There was one flap loss. Clinical long-term assessment at 15-year median follow-up (range, 1–27 years) showed good results, assuring facial height and contour. Radiological long-term results demonstrated excellent integration of the flap to the adjacent facial skeleton of the growing child. Conclusions: Prefabricated vascularized calvarium flaps are an effective, safe and lasting method for reconstruction of facial bone defects in children.