microvascular and maxillofacial surgery
TRANSCRIPT
MICROVASCULAR AND
MAXILLOFACIAL SURGERY
Microvascular surgeryMicrovascular reconstructive surgery involves the
transfer of autogenous vascularized tissue to reconstruct extensive tissue defects.
Areas commonly reconstructed include the jaws and mouth, the throat, and all areas of the face, scalp, and neck.
Microsurgery uses the operating room microscope or high-powered loupe magnification to aid in the techniques of microvascular surgery to anastomose small vessels and nerves
How does it help?With intimal injury, exposed collagen triggers platelet
adhesion. Platelets aggregate and activate fibrinogen, which adheres to platelets and acts to link platelets together to form a platelet plug. Fibrinogen is converted to fibrin, strengthening the platelet plug. If the vessel walls are not damaged and the anastomosis is secure, the platelet plug gradually disappears over the first 3-5 days. New endothelium covers the anastomotic site 1-2 weeks later.
Reconstructive LadderThe term coined by reconstructive plastic
surgeons to describe levels of increasingly complex management of wounds.
Rung 1: Healing by secondary intentionRung 2: Primary closureRung 3: Delayed primary closureRung 4: Split thickness graftRung 5: Full thickness skin graftRung 6: Tissue expansionRung 7: Random flapRung 8: Axial flapRung 9: Free flap
Free Tissue TransferDefect Type Tissue Defect Common Flaps
Coverage of exposed structures
Open tibial fractures in the distal third of the leg
Latissimus dorsi muscle free flap; gracilis muscle free flap
Dead space Obliteration of maxilla defect after maxillectomy for cancer
Rectus abdominus muscle free flap
Tissue defect Breast reconstruction Transverse rectus abdominus myocutaneous (TRAM) free flap; deep inferior epigastric perforator (DIEP) flap; superior gluteal artery perforator (SGAP) free flap
Facial muscle denervation
Facial paralysis with muscular atrophy
Gracilis muscle free flap
Digital amputation
Thumb amputation Great toe composite free flap
Digestive tract defect
Esophageal reconstruction
Jejunum free flap; anterior lateral thigh (ALT) free flap
Work upPreoperative planning includes finding the optimal donor
site and designing the flap to maximize soft tissue coverage, functionality, and appearance and to minimize complications. In oncologic cases, the timing of free flap reconstruction should be coordinated with the oncology team, taking into consideration chemotherapy and radiation treatments.
After the decision has been made to proceed with a microsurgical reconstruction, the optimal flap must be chosen. This decision is based on the size of the defect, the type of tissue required for the repair (bone, muscle, fascia, tendon, nerve, skin), and the reliability of the flap.
Common FlapsAnterior lateral thigh flapRadial forearm flapLateral arm flapScapular flapLatissimus dorsi flapRectus abdominis flapSuperficial inferior epigastric artery flap (SIEA)Gracilis flapTensor fascia lata flapOmental flap Jejunal flapFibula flapGreat toe flap
Gracilis Flap
Gracilis Flap
Gracilis Flap
Gracilis Flap
Antero lateral thigh Flap
Antero lateral thigh Flap
Antero lateral thigh Flap
Antero lateral thigh Flap
ComplicationsPostoperative complications include the following:Flap compromise due to vein or artery thrombosisFlap congestionFat necrosisHematoma with pedicle compromise and need for
transfusionInfectionWound breakdownWound complication associated with the donor siteSystemic complications associated with anesthesiaDeep vein thrombosis and pulmonary emboli
Maxillofacial SurgeryOral and maxillofacial surgery is a branch of surgery to
correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.
It is a recognized international surgical specialty.
Treatments performed by maxillofacial surgeons include:Dentoalveolar surgeryDiagnosis and treatment of benign and malignant
pathology, cysts, tumors etc.Diagnosis and treatment of congenital craniofacial
malformations such as cleft lip and palateDiagnosis and treatment of soft and hard tissue trauma of
the oral and maxillofacial region (jaw fractures, cheek bone fractures, nasal fractures, LeFort fracture, skull fractures and eye socket fractures).
Diagnosis and treatment of chronic facial pain disorders.Diagnosis and treatment of temporomandibular joint
(TMJ) disorders.
Craniofacial SurgeryCraniofacial surgery is a
surgical subspeciality of plastic surgery and oral and maxillofacial surgery that deals with congenital and acquired deformities of the skull, face, and jaws.
Defects typically treated by craniofacial surgeons
include rare craniofacial clefts, acute and chronic sequellae of facial fractures, cleft lip and palate, micrognathia, and many others.
Cleft lip
Cleft lip
Cleft lip
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