Reconstruction of Osteomyelitis Defects of the Craniofacial Skeleton

Osteomyelitis of the craniofacial skeleton closely resembles osteomyelitis elsewhere in the body in its pathophysiology and medical management; subsequent reconstruction after debridement remains distinctly challenging. The goals of reconstruction must include the restoration of the complex and readily visible morphology of the cranium and face, as well as the adequate return of vital sensory, expressive, and digestive functions. In this article, the various reconstructive modalities will be discussed including pedicled and nonpedicled flaps with or without an osseous component, nonvascularized bone grafts, alloplastic implants, and bone regeneration using protein therapy. Although reconstruction of craniofacial defects after osteomyelitis commonly proves formidable, the satisfactory return of form and function remains a plausible reconstructive goal

Surgical management of a nasal AVM in a pediatric patient: A case report

Arteriovenous malformations (AVMs) are a type of high-flow vascular malformation that are characterized by abnormal capillary communications between the arterial and venous systems. While they are most commonly located in the head and neck region, their appearance in the nose is considerably rare, resulting in a paucity of literature regarding the surgical management of these lesions. We present the case of a 13-year-old male with a 6.5 × 6 cm AVM of the nose with a history of frequent nosebleeds since early childhood, often requiring aggressive measures, such as silver nitrate cauterization for control. Use of nasal decongestants and aminocaproic acid provided only transient improvement. After determination of arterial supply, AVM was approached with a combination of preoperative selective embolization and surgical excision with subsequent forehead flap defect coverage. Due to the size and complexity of this AVM, extra precautions were taken to avoid severe intraoperative bleeding, and femoral sheaths were placed prior to excision. The patient tolerated the procedure well, and with subsequent debulking surgery and Laser Hair Removal achieved an acceptable cosmetic outcome. Keywords: AVM, Pediatric arteriovenous malformation, Forehead flap, Selective embolizatio

Customized Titanium Implant for Chest Wall Reconstruction in Complex Poland Syndrome

Summary: This report describes a new method for the surgical repair of the chest wall deformity encountered in complex Poland’s syndrome. In this report, we describe the use of a customized titanium implant that was used to replace the missing second through fifth ribs and to provide chest wall stabilization before breast reconstruction. This approach might be considered an alternative to autologous rib grafting in patients who have reached skeletal maturity. It avoids the morbidity and risk associated with rib grafts and improves chest wall symmetry

Designing a Fibular Flow-Through Flap with a Proximal Peroneal Perforator-Free Flap for Maxillary Reconstruction

Summary:. Reconstruction of a composite maxillary defect is frequently performed with a fibular osteocutaneous free flap to address both the bony and mucosal defect. If during the harvest of the fibula a distal skin perforator is not present due to vascular variations, reconstruction can potentially be done using the soleus muscle for filling of the palatal mucosal defect. An additional challenge arises when the accompanying skin paddle that has been harvested is not perfused, but the fibula remains viable. This case report describes salvage following loss of the skin paddle in an osteocutaneous fibular free flap by designing a fibular flow-through flap using a proximal peroneal perforator free flap. The use of this second free flap allows a skin paddle to be positioned on the distal fibular segment, provides a surgical backup, and limits the donor sites to the same extremity

Supercharging and Augmenting Venous Drainage of an Anterolateral Thigh Free Flap: Options and Indications

Summary: This study introduces the options for supercharging and augmenting venous drainage of an anterolateral thigh free flap. Clinical indications and options for additional microvascular anastomoses are reviewed in 5 consecutive patients. The indications were simultaneous mucosal and cutaneous defects, divergent mucosal defects, and extensively wide and long cutaneous defects. Three additional vascular pedicles were anastomosed: the transverse branch of the lateral circumflex (n = 3), a perforator coming directly off the superficial femoral artery (n = 1), and a posterior perforator from the profundus femoral artery (n = 1). The anastomosis of a separate pedicle from the superior, medial, and/or posterior-lateral thigh may be a useful technique when confronted with an extensive defect that may not reliably be reconstructed with a routine anterolateral thigh flap based on a single perforator