Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction
Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold repre...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/17/4373 |
| _version_ | 1797521605833785344 |
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| author | Remo Accorona Luca Gazzini Roberto Grigolato Enrico Fazio Letizia Nitro Monir Abousiam Giovanni Giorgetti Lorenzo Pignataro Pasquale Capaccio Luca Calabrese |
| author_facet | Remo Accorona Luca Gazzini Roberto Grigolato Enrico Fazio Letizia Nitro Monir Abousiam Giovanni Giorgetti Lorenzo Pignataro Pasquale Capaccio Luca Calabrese |
| author_sort | Remo Accorona |
| collection | DOAJ |
| description | Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (<i>n</i> = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (<i>n</i> = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site. |
| first_indexed | 2024-03-10T08:14:54Z |
| format | Article |
| id | doaj.art-ad5a275e530d4f1a842331ee1e2c3809 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T08:14:54Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ad5a275e530d4f1a842331ee1e2c38092023-11-22T10:26:27ZengMDPI AGCancers2072-66942021-08-011317437310.3390/cancers13174373Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular ReconstructionRemo Accorona0Luca Gazzini1Roberto Grigolato2Enrico Fazio3Letizia Nitro4Monir Abousiam5Giovanni Giorgetti6Lorenzo Pignataro7Pasquale Capaccio8Luca Calabrese9Department of Otorhinolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyDepartment of Otorhinolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyDepartment of Otorhinolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, ItalyDepartment of Otorhinolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, ItalyDivision of Otorhinolaryngology, “San Maurizio” Hospital, 39100 Bolzano, ItalyIntroduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (<i>n</i> = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (<i>n</i> = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.https://www.mdpi.com/2072-6694/13/17/4373head and neck reconstructionperiosteumfree flapfree periosteal flap |
| spellingShingle | Remo Accorona Luca Gazzini Roberto Grigolato Enrico Fazio Letizia Nitro Monir Abousiam Giovanni Giorgetti Lorenzo Pignataro Pasquale Capaccio Luca Calabrese Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction Cancers head and neck reconstruction periosteum free flap free periosteal flap |
| title | Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction |
| title_full | Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction |
| title_fullStr | Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction |
| title_full_unstemmed | Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction |
| title_short | Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction |
| title_sort | free periosteal flaps with scaffold an overlooked armamentarium for maxillary and mandibular reconstruction |
| topic | head and neck reconstruction periosteum free flap free periosteal flap |
| url | https://www.mdpi.com/2072-6694/13/17/4373 |
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