Speciality of Hand Surgery | Replantation | Dos & Donts | First Aid | Tendon Injuries | Nerve Injuries | Common Hand Conditions | Rheumatoid Arthritis | Fused Fingers | Radial Club Hand | Brachial Plexus Injuries | Post cancer reconstruction | Vascularised bone graft | Spastic | Soft tissue reconstruction  | Cleft Lip & Palate | Fellowship Training Programme | Micro Surgery Training Institute |



The fibula compared with hemimandible


Fibula contured with osteotomies to 
shape like the missing half of the mandible

and fixed with mini plates.

Post cancer surgery reconstruction

Cancers  of head and  neck region accounts for majority of all cancers in our country. Tobbaco chewing and alcohol are the major risk factors associated with these cancers. Resection of such cancerous lesions results in facial deformities which are not only cosmetically disfiguring but also functionally debilitating. Conventional reconstructive techniques lead to suboptimal results and significant donor site morbidity.However the advent of microsurgical reconstructive techniques has helped to adress the pitfalls associated with conventional reconstructive techniques.The development of microsurgical reconstruction and multidisciplinary team approach in treating malignancies has resulted in significant improvements in the quality of life of these patients following such surgical procedures . Tissues are harvested along with the associated blood vessels in such a way so as to result in minimal donor site morbidity.

Advantages of Microsurgical Reconstruction Include

· Early rehabilitation
· Better cosmetic appearance
· Earlier radiotherapy
· Better application of prosthesis(dentures)
· Less donor site problems.

 

Soft Tissue Reconstruction

Cancer involving the cheeks, lip, soft palate, tongue, when removed result in a grossly disfigured face reconstructing which is technically demanding.  The advent of microvascular free flaps has helped immeasurably in reconstructing such defects.  The defect can be planned, marked  in the donor area and harvested accordingly along with the associated pedicle (blood vessels).  The most common donor sites for soft tissue include :

  • Radial forearm flap
  • Latissimus dorsi muscle flap with skin paddle
  • Anterolateral thigh flap
  • Scapula flap

The above donor site also heal with the least morbidity and cause no aesthetic or functional problems to the patient.

Front view with cancer

 

Side view with cancer

 

Defect After Cancer Resection

 

Flap Harvested from Forearm
(Radial forearm flap)

 

Post op Frontal View

Post op Side View

Post op Mouth Opening

Mandibular (Jaw) reconstruction

Following mandibular resection  for  cancer,  there remains unsightly disfigurement of the face. Loss of bone(maxilla or mandible)results in lack of support to the structures such as the cheeks,lips and tongue resulting in functional as well as cosmetic deformities. The bony defects can be corrected   by microsurgical bone transfers. Immediate mandible reconstruction after tumour resection offers definitive advantages. The preferred method of reconstruction of resected  mandible is using vascularised Fibula (smaller leg bone). The fibula is harvested from the leg, shaped according  to  the  bony defect and fixed in place with titanium plates and screws.The blood supply to the bone is restored by joining its blood vessels to the blood vessels in the neck by microsurgical technique. The copmmon sites from where bone can be harvested for such reconstruction are:

  • FIbula - Smaller leg bone
  • Iliac Crest - Hip bone
  • Scapula - Shoulder bone

Pre op Frontal View

Pre op Mouth Opening

Intra Oral View of Cancer


 

 

 

Mandibular Defect After Cancer Resection

 

 

 

Bone Harvested from the Leg (Fibula)

 

New Bone (Fibula) Bridging the Defect

 

Pre op Radiograph

Post op Radiograph

 

Post op Frontal View

Post op Mouth opening


Post op Occlusion and Function