Maxilectomía total con preservación del contenido orbitario: Reconstrucción con el colgajo microquirúrgico de rectus abdominis

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Abstract

OBJETIVOS: Se presentan dos pacientes en las cuales, se les realizó una maxilectomía con preservación de la órbita, y que, fueron reconstruidos en forma inmediata con un colgajo libre de rectus abdominis. RESULTADOS: Los resultados funcionales y cosméticos obtenidos en estas dos pacientes fueron satisfactorios luego de la resección oncológica de una maxilectomía total derecha con preservación del contenido orbitario, en el primer caso, por un fibromixoma y en el segundo, por un fibrosarcoma. Se utilizó malla de titanio en la reconstrucción del piso de la órbita. Se realizó una anastomosis termino-lateral entre la vena epigástrica inferior y la vena yugular interna, y una anastomosis termino-terminal entre la arteria epigástrica inferior y la arteria radial. CONCLUSIÓN: El colgajo libre de rectus abdominis es el mejor método para la reconstrucción de defectos faciales grandes, permite trabajar con dos equipos quirúrgicos, y suministra suficiente tejido para rellenar cavidades faciales.

Translated abstract

OBJECTIVE: We present two patients in which, a maxilectomía with preservation of the orbit was made to them, and they were reconstructed in immediate form with rectus abdominis free flap. RESULTS: The functional and cosmetic results obtain in these two patients were satisfactory. Inmediate reconstruction after onco-logy resection of right total maxillectomy with preservation of orbital contens with rectus abdominis free flap; the first patients had a fibromixoma, and the other one, a fibrosarcoma. We used titanium mesh in the orbit’s floor reconstruction. We realized a termino-lateral anastomosis of the inferior epigastric vein and tirolingual-facial trunck, and a termino-terminal anastomosis between the inferior epigastric artery and the inferior thyroid artery. CONCLUSION: The rectus abdominis free flap is the best method for reconstruction of big facial defects, allows two surgical teams approach and brings enough tissue to fill big cavitys.

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Most cited references 25

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The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.

S Ariyan (1978)

A compound flap is described that utilizes skin from the anterior chest on a narrow segment of pectoralis major muscle, with its underlying axial neurovascular bundle. This flap has been used successfully to reconstruct large defects in 4 consecutive patients. Our experience with this flap suggests that it may be more versatile than the deltopectoral flap.

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A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.

E Santamaria, Arthur Cordeiro (2000)

Maxillectomy defects become more complex when critical structures such as the orbit, globe, and cranial base are resected, and reconstruction with distant tissues becomes essential. This study reviews all maxillectomy defects reconstructed immediately using pedicled and free flaps to establish (1) a classification system and (2) an algorithm for reconstruction of these complex problems. Over a 5-year period, 60 flaps were used to reconstruct defects classified as the following: type I, limited maxillectomy (n = 7); type II, subtotal maxillectomy (n = 10); type IIIa, total maxillectomy with preservation of the orbital contents (n = 13); type IIIb, total maxillectomy with orbital exenteration (n = 18); and type IV, orbitomaxillectomy (n = 10). Free flaps (45 rectus abdominis and 10 radial forearm) were used in 55 patients (91.7 percent), and the temporalis muscle was transposed in five elderly patients who were not free-flap candidates. Vascularized (radial forearm osteocutaneous) bone flaps were used in four of the 60 patients (6.7 percent) and nonvascularized bone grafts in 17 (28.3 percent). Simultaneous reconstruction of the oral commissure using an Estandler procedure was performed in 10 patients with maxillectomy and through-and-through soft-tissue defects. Free-flap survival was 100 percent, with reexploration in five of 55 patients (9.1 percent) and partial-flap necrosis in one patient. Seven of the 60 patients (11.7 percent) had systemic complications, and four died within 30 days of hospitalization. Fifty patients had more than 6 months of follow-up with a mean time of 27.7 (+/- 15.6) months. Postoperative radiotherapy was administered in 32 of these patients (64.0 percent). Chewing and speech functions were assessed in 36 patients with type II, IIIa, and IIIb defects. A prosthetic denture was fixed in 15 of 36 patients (41.7 percent). Return to an unrestricted diet was seen in 16 patients (44.4 percent), a soft diet in 17 (47.2 percent), and a liquid diet in three (8.3 percent). Speech was assessed as normal in 14 of 36 patients (38.9 percent), near normal in 15 (41.7 percent), intelligible in six (16.7 percent), and unintelligible in one patient (2.8 percent). Globe and periorbital soft-tissue position was assessed in 14 patients with type I and IIIa defects. There were no cases of enophthalmos, and one patient had a mild vertical dystopia. Ectropion was observed in 10 of 14 patients (71.4 percent). Oral competence was considered good in all 10 patients with excision/reconstruction of the oral commissure; however, two patients (20 percent) developed microstomia after receiving radiotherapy. Aesthetic results were evaluated at least 6 months after reconstruction in 50 patients. They were good to excellent in 29 patients (58 percent) for whom cheek skin and lip were not resected, and poor to fair (42 percent) when the external skin or orbital contents were excised. Secondary procedures were required in 16 of 50 patients (32.0 percent). Free-tissue transfer provides the most effective and reliable form of immediate reconstruction for complex maxillectomy defects. The rectus abdominis and radial forearm flaps in combination with immediate bone grafting or as osteocutaneous flaps reliably provide the best aesthetic and functional results. An algorithm based on the type of maxillary resection can be followed to determine the best approach to reconstruction.

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The Pectoralis Major Myocutaneous Flap A Versatile Flap for Reconstruction in the Head and Neck

Stephan Ariyan (1979)

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Contributors

Alberto Pérez-Morell: Role: ND

Joaquín Lugo: Role: ND

Santiago Sosa: Role: ND

Telma Ruiz: Role: ND

Javier Merchan: Role: ND

Journal

Journal ID (publisher): rvo

Title: Revista Venezolana de Oncología

Abbreviated Title: Rev. venez. oncol.

Publisher: Casa publicadora Ateproca C.A (Caracas )

ISSN: 0798-0582

Publication date (Print): March 2006

Volume: 18

Issue: 1

Pages: 43-48

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[1 ] INSTITUTO MÉDICO LA FLORESTA VENEZUELA

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Publisher ID: S0798-05822006000100008

SO-VID: 15315e8a-74b9-4103-963d-b6c3e770bf61

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http://creativecommons.org/licenses/by/4.0/

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SciELO Venezuela

Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0798-0582&lng=en

Maxilectomía total con preservación del contenido orbitario: Reconstrucción con el colgajo microquirúrgico de rectus abdominis

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SciELO Venezuela

Most cited references 25

The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.

A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.

The Pectoralis Major Myocutaneous Flap A Versatile Flap for Reconstruction in the Head and Neck

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