Search Results (58)

The surgical management of extremity bone defects, particularly post-traumatic nonunion wounds, remains a challenge. Vascularized bone flaps (VBFs), widely used for mandibular reconstruction in head and neck oncologic surgery, are less established in extremity reconstruction and are typically performed freehand, which has several limitations. In the past decade, virtual surgical planning (VSP) and computer-aided design and modeling (CAD-CAM) technology have enabled patient-specific 3D-printed models to guide reconstruction. While this technology has been used extensively in head and neck reconstructive surgery, its application to extremity reconstruction is less well-documented. This case series evaluates the feasibility, safety, and surgical utility of VSP and in-house CAD-CAM manufacture of 3D-printed models and cutting guides for post-traumatic non-healing extremity reconstructions using VBFs. Eight patients at a single tertiary academic center underwent VBF reconstruction guided by patient-specific models and cutting guides, with cases grouped into categories (humerus, femur, and tibia). The multi-disciplinary workflow supported preoperative visualization, osteotomy planning, and intraoperative execution. All vascularized flaps survived, and radiographic union was documented in patients with adequate follow-up. These findings suggest that integrating VSP and CAD-CAM into trauma-associated VBF extremity reconstruction is feasible and safe and may improve reconstructive accuracy and enhance multi-disciplinary team workflow, potentially contributing to improved clinical outcomes. Full article

Background: Forearm nonunions represent a challenging clinical condition that significantly impairs upper limb function. Various surgical techniques have been proposed, including vascularized bone grafts. Although these procedures are not considered first-line treatment, they play a crucial role in complex or recalcitrant cases, particularly after failure of conventional methods, where their superior biological potential can significantly enhance bone healing. Despite the widespread use of the medial femoral condyle corticoperiosteal flap, simultaneous bilateral harvest has not been previously described in the literature. Case Presentation: We report the case of a 50-year-old male presenting with persistent nonunions of both the radius and ulna following previous osteosynthesis and revision surgery with iliac crest bone graft. The patient was successfully treated using bilateral vascularized corticoperiosteal free flaps harvested from both medial femoral condyles. Conclusions: Double vascularized corticoperiosteal free flaps may represent an effective and reliable option for the treatment of complex forearm nonunions, especially in cases with multiple previous surgical failures. To the best of our knowledge, this case represents the first report of simultaneous bilateral medial femoral condyle corticoperiosteal flap harvest. Full article

Background: Large segmental bone defects remain a major challenge in reconstructive surgery, particularly in the presence of impaired vascularization. Despite advances in scaffold design and biomaterials, insufficient vascular supply continues to represent the primary limitation in bone tissue engineering, often leading to impaired osteogenesis and graft failure. Objective: This review aims to analyze the role of vascularized flaps as “living bioreactors” in bone tissue engineering, focusing on their capacity to enhance scaffold vascularization, support osteogenesis, and facilitate clinical translation. Methods: A narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science using combinations of the following keywords: “bone tissue engineering”, “vascularized flaps”, “arteriovenous loop”, and “in vivo bioreactor”. Relevant preclinical and clinical studies were selected based on their contribution to vascularization strategies in scaffold-based bone regeneration, with the aim of illustrating the evolution and integration of these approaches. Results: Vascularized flaps provide an established vascular network and a biologically active microenvironment that promote scaffold integration and tissue regeneration. Periosteal flaps demonstrate strong osteogenic potential, whereas muscle and omental flaps primarily act as vascular carriers and adaptable regenerative environments. AV loop-based strategies enable intrinsic axial vascularization, ensuring rapid and homogeneous perfusion of large constructs. Hybrid approaches, including regenerative matching axial vascularization (RMAV), integrate vascularized tissues with advanced biomaterials and show promising translational outcomes. Conclusions: Vascularization-driven strategies represent a paradigm shift in bone tissue engineering, moving from passive scaffold implantation to actively engineered, vascularized constructs. The integration of microsurgical techniques with advanced biomaterials offers significant potential for the development of personalized and clinically applicable bone regeneration strategies. Full article

Background/Objectives: Contemporary implant dentistry is increasingly oriented toward minimally invasive regenerative strategies designed to reduce surgical morbidity while preserving or improving clinical outcomes. Conventional bone augmentation procedures remain effective and biologically well established, but they may be associated with greater patient burden, increased risk of complications, and higher technical demands in selected clinical scenarios. This narrative review critically examines minimally invasive bone regeneration approaches in implant dentistry, with particular focus on the Bone Core Technique, the Sub-Periosteal Peri-implant Augmented Layer (SPAL) technique, and Immediate Dentoalveolar Restoration (IDR), emphasizing their biological rationale, clinical indications, surgical workflows, limitations, and reported outcomes. Methods: A structured, non-systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify publications relevant to minimally invasive bone regeneration in implant dentistry. Priority was given to clinical studies, prospective cohorts, case series, technical descriptions, and biologically oriented conceptual papers addressing vascular preservation, flap limitation, donor-site morbidity, and peri-implant hard- and soft-tissue integration. Results: Available evidence suggests that minimally invasive regenerative protocols may offer favorable clinical and patient-centered outcomes only in carefully selected indications and when performed by experienced operators. The strength of support is uneven across techniques: the Bone Core Technique currently has the strongest dedicated prospective follow-up for localized peri-implant defects, SPAL is supported by limited retrospective and emerging histologic evidence, and IDR remains largely based on case reports, technique-driven descriptions, and broader immediate implant literature. Conclusions: Minimally invasive bone regeneration reflects a shift toward biologically guided and patient-centered treatment concepts in implant dentistry, but it should not be interpreted as a universal substitute for conventional augmentation. Its successful application depends on careful case selection, sound knowledge of wound healing and defect morphology, and advanced surgical and prosthetic expertise. Further research should prioritize standardized outcome measures, longer follow-up, and comparative prospective studies. Full article

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator—a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical. Full article

Traumatic thumb loss causes severe functional impairment, as the thumb provides approximately 40% of total hand function. Toe-to-thumb transfer remains the gold standard for thumb reconstruction, yet donor site morbidity represents a significant functional and aesthetic limitation. A total thumb reconstruction using a “trimmed” right great toe transfer, combined with immediate donor site reconstruction using a free SCIP (superficial circumflex iliac perforator) flap and iliac crest bone graft. The flap was designed as a tubular skin island to create a neo-hallux with optimal contour and volume, minimizing visible scarring and avoiding microcirculatory compression. The patient, a 33-year-old man with post-traumatic thumb avulsion, underwent delayed reconstruction three months after injury. The postoperative course was uneventful, with no vascular or wound complications. At 12 months, he resumed full ambulation and manual activities, including motorcycle driving and work tasks. Baropodometric analysis demonstrated symmetric load distribution and gait dynamics. Thumb opposition was satisfactory (Kapandji score: seven); the patient rated the aesthetic results as excellent. This case demonstrates that SCIP flap reconstruction with iliac crest bone graft enables complete functional and aesthetic restoration of the great toe donor site after total toe transfer. Compared to previous techniques using cross-flaps, skin grafts, or peroneal flaps, this approach minimizes morbidity, optimizes cosmetic outcomes, and preserves gait. Although representing a single case, this constitutes the first documented instance of total hallux reconstruction following toe-to-thumb transfer, emphasizing the importance of the foot as a functional and aesthetic unit and the need for donor-site preservation in microsurgical reconstructive planning. Full article

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making. Full article

Ossification of the vascular pedicle following fibula free flap (FFF) reconstruction is an uncommon and typically asymptomatic complication. Symptomatic cases requiring intervention are rare. We report a 29-year-old man with anterior maxillary osteosarcoma who underwent tumor resection followed by reconstruction with an osteocutaneous FFF. Calcification within the surgical site region was noted on imaging at two months after fibular reconstruction. By five months, he developed progressive trismus and pain with mastication. Computed tomography demonstrated a calcified structure extending from the mandible to the reconstructed maxilla along the flap pedicle, raising concern for tumor recurrence. Surgical excision was performed, and histopathology revealed benign woven bone without evidence of malignancy. Postoperatively, trismus improved, and flap viability was preserved. Retained periosteum during FFF harvest maintains osteogenic potential and may result in pedicle ossification. In symptomatic patients, particularly when recurrence is suspected, surgical resection is both diagnostic and therapeutic. Full article

Reconstruction of craniomaxillofacial (CMF) bony defects requires individualized strategies based on defect characteristics and graft bed biology, with traditional approaches relying on autogenous non-vascularized bone grafts or vascularized free flaps that, while reliable, are associated with donor-site morbidity and operative complexity. Biologically driven reconstructive strategies, including tissue engineering, cellular bone matrix allografts (CBMs), and growth factor adjuncts, have emerged as alternatives or complements to autograft-based reconstruction. This review introduces and details these new innovations with emphasis on the current literature, thus empowering surgeons to enhance their clinical armamentarium. Full article

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary orbital reconstruction using a combined scalp flap and temporalis muscle flap (TMF), referred to as the “Pacman flap with tongue,” performed prior to prosthetic rehabilitation. Materials and Methods: Five elderly patients with multiple comorbidities and osteoradionecrosis following orbital exenteration and radiotherapy underwent secondary orbital reconstruction using the “Pacman flap with tongue” technique. The clinical outcomes, flap viability, complications, and feasibility of subsequent prosthetic rehabilitation were assessed. After stabilization of healing, digitally planned ocular epitheses were fabricated using cone-beam computed tomography (CBCT), computer-aided design, and three-dimensional printing. Results: Healing was uneventful in all patients. No flap necrosis, wound dehiscence, or recurrent bone exposure was observed. The reconstructed orbital sockets provided a stable, well-vascularized prosthetic bed, enabling satisfactory prosthetic rehabilitation. Conclusions: The “Pacman flap with tongue” may be considered a feasible option for secondary orbital reconstruction in selected high-risk patients, particularly in the setting of osteoradionecrosis. Full article

Background/Objectives: Virtual surgical planning (VSP) and CAD/CAM technologies have revolutionized complex maxillofacial reconstruction. While high-resolution imaging is critical for these workflows, the specific clinical impact of photon-counting computed tomography (PCCT) remains to be fully established. This prospective pilot study evaluates the feasibility and clinical utility of integrating PCCT into the preoperative planning and surgical workflow of complex maxillofacial reconstructive cases. Methods: This feasibility study included ten patients requiring complex maxillofacial reconstruction with microvascular free flaps. All underwent preoperative imaging with photon-counting CT. Primary endpoints included clinical assessment of osseous invasion, reliability of donor-site vascular mapping from a single acquisition, and compatibility of PCCT datasets with VSP/CAD-CAM platforms. Secondary endpoints included resection margin status, flap survival, and short-term oncologic outcomes. Results: PCCT provided high-resolution visualization of cortical and medullary bone, enabling detailed assessment of tumor-related osseous involvement. In selected cases, findings supported refinement of resection planning when prior imaging had been inconclusive. Spectral reconstructions reduced metal artifacts and facilitated precise segmentation for multi-segment osteotomies. Donor-site vascular anatomy was successfully evaluated within the same scan, supporting operative planning without additional imaging. PCCT datasets were fully compatible with the virtual surgical planning (VSP) software used in this study (CMX Portal, version 2.6.1158, Medartis AG, Basel, Switzerland; or ProPlan CMF, version 5.7.8.025, Materialise NV, Leuven, Belgium) in all cases (100%). Reconstruction was completed successfully in all patients, with 100% flap survival and R0 margins in all malignant cases. No technical failures occurred during imaging transfer or CAD/CAM fabrication. Conclusions: The integration of PCCT into the surgical workflow proved technically feasible and clinically impactful. This pilot data supports its potential to enhance surgical precision and preoperative planning in complex jaw reconstruction. Full article

Background/Objectives: Locally advanced midface malignant tumors require extensive resection, resulting in complex defects involving bone and multiple soft tissue structures. Reconstructing these substantial defects presents a significant challenge to restore both function and aesthetics. This study aims to compare the functional and aesthetic outcomes of chimeric free flaps versus single free flaps in midface microvascular reconstructions. Methods: This retrospective analysis included fifty consecutive patients with Type III Cordeiro defects who underwent midface reconstruction with free tissue transfer between 2020 and 2024. The cohort included fourteen patients who received prefabricated chimeric flaps and thirty-six patients who received single free flaps. Outcomes were assessed six months postoperatively using a modified University of Washington Quality of Life Questionnaire (UW-QOL), analyzing domains including speech, chewing, sensation, appearance, pain, and social activity. Statistical analysis was performed using the Mann–Whitney U test. Results: In the chimeric flap group, no major flap necrosis or complications were observed. In unadjusted comparisons, the chimeric flap group showed higher transformed UW-QOL scores in several domains. Statistically significant between-group differences were observed for opening and speech (p = 0.004), change in appearance (p = 0.022), sensation (p = 0.011), and social activity (p = 0.006). Aesthetic outcomes, assessed via patient rating of appearance, were also significantly higher in unadjusted comparisons with the chimeric flap approach. Furthermore, in Type IIIa defects, titanium mesh successfully provided reliable orbital support. Conclusions: Chimeric free flaps represent a feasible reconstructive option in selected cases of complex maxillary and midface reconstruction. Their main advantages—providing the proper amount of specific, well-vascularized tissue and offering greater mobility of components— may be associated with more favorable functional, aesthetic, and social outcomes in unadjusted comparisons compared to reconstruction using single free flaps. Full article

Background/Objectives: Maxillofacial reconstruction with a vascularized free bone flap for facial contour restoration serves as a foundation for dentition rehabilitation. Although state-of-the-art studies have reported promising results with implant-supported prostheses in such cases, evidence for dental implant prognosis remains insufficient. This study aims to synthesize the mid-term clinical outcomes of implants placed in vascularized free bone flaps, taking into account the biological responses and associated complications. Methods: Studies with a minimal 3-year follow-up, no less than 10 patients, and reporting implant survival/success rate were included. Literature published from 2000 to 2025 was collected from PubMed, Embase, and Scopus. Meta-analyses were performed to pool the implant survival and success rates for the entire cohort, the biological complication rates, the odds ratio for radiotherapy, and the pooled implant failure rates associated with radiotherapy. Parameters related to biological prognosis were collected. ROBINS-E and NOS scale were used to assess the risk of bias. Results: Of the 949 records identified, 14 retrospective and 2 cohort studies were included, yielding a total of 1165 dental implants placed in free bone flaps. On the implant level, meta-analysis demonstrated a pooled implant survival rate of 97.9% (95% CI: 0.922–0.994, I² = 64.4%) and a pooled implant success rate of 88.1% (95% CI: 0.803–0.931, I² = 68.3%). The pooled biological complication rate was 8.6% (95% CI: 0.052–0.138; I² = 69.5%). Among patients who underwent radiotherapy, the pooled implant failure rate was 13.7% (95% CI: 0.087–0.210; I² = 0.0%; p = 0.4702) with an odds ratio of 3.086 (I² = 66.5%) for radiotherapy-associated implant failure. Conclusions: Implant-related outcomes in these complex cases are generally acceptable, with high survival, moderately high success rates and overall stable biological response. Additionally, radiotherapy adds to the risk of implant failure on implant level. However, the statistical heterogeneity and inconsistent definitions of biological outcomes in the literature suggest that caution is warranted when planning implant therapy in these cases. Further studies with long-term follow-up, focused on peri-implant tissue conditions and adopting more stratified study designs to minimize confounding factors, are needed. Full article

Background: Auricular carcinoma is a malignant neoplasm arising from the epithelial or adnexal tissues of the external ear, most commonly representing cutaneous squamous cell carcinoma, basal cell carcinoma, or, less frequently, melanoma, characterized by early cartilage invasion and regional spread due to the thin soft-tissue envelope of the ear. Such malignancies involve radical resection, producing wide defects, which require complex reconstructive approach. Case Presentation and Methods: We describe a 45-year-old male patient who presented with a basal cell carcinoma, affecting the lobulus of the ear and the retroauricular and mastoid region. He underwent successful tumor resection with clear resection margins in an ENT department with a subsequent referral to our department for reconstruction. This report presents a successful reconstruction of a large post-excisional defect, 10 × 10 cm in diameter, with mastoid process exposure. Temporal muscle flip flap and skin graft, along with the preservation of the external auditory canal with Z-plasty, were incorporated for reconstruction after subtotal auricular amputation due to BCC. It highlights the importance of a diligent long-term follow-up, the preservation of the canal, preventing meatal stenosis, and the reconstructive potential of the muscle flap in patients with mastoid bone exposure in a single stage. Conclusions: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis. Full article

The objective of the present study is to review the anatomical considerations, surgical techniques, clinical applications, and outcomes of myocutaneous and muscle flaps used in the reconstruction of limb defects in dogs and cats. Limb wounds in small animals often result from trauma, neoplasia, or infection and can involve significant soft tissue loss. Reconstruction of these defects is challenging due to limited local skin availability, particularly in distal regions, and the need to preserve function while preventing complications. Muscle and myocutaneous flaps provide well-vascularized tissue suitable for covering complex wounds, especially those with exposed bone, joints, or tendons. This review synthesizes current literature on commonly used flaps—including latissimus dorsi, cutaneous trunci, trapezius, sartorius, semitendinosus, and flexor carpi ulnaris; focusing on their anatomical basis, vascular supply, arc of rotation, surgical technique, indications, and complication rates. Comparative data between dogs and cats are highlighted, and experimental as well as clinical applications are discussed. Myocutaneous flaps offer durable and reliable coverage with lower infection and necrosis rates compared to skin grafts, particularly in contaminated or poorly vascularized wounds. Common complications include distal flap necrosis, wound dehiscence, seroma, and, occasionally, functional deficits. Muscle and myocutaneous flaps remain essential tools in limb reconstruction. Successful outcomes require careful flap planning, surgical expertise, and vigilant postoperative care. Further prospective studies are needed to optimize flap selection and reduce complication rates in both species. Full article