Reconstruction of a post-traumatic mine-explosive subtotal defect of the lower jaw with a free peroneal autograft on microvascular anastomoses

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Abstract

Mine-explosive wounds of the maxillofacial region lead not only to defects in the bones of the facial skull but also to defects in the soft tissues of the face and neck. To eliminate defects during the installation of titanium structures, the problem arises of the adequate wrapping and closing with soft tissues without tension, which is often impossible even with the use of local tissue plasty methods. The tension of the soft tissues undoubtedly leads to the failure of the sutures, the exposure of the plate and traumatic osteomyelitis of the bones of the facial skull. Simultaneous bone grafting of extensive jaw defects using free bone autografts with an included skin cushion is a reliable method for replacing defects in the maxillofacial region. This method allows in a short time to achieve rehabilitation of the patient, improve the quality of life and increase patient satisfaction with the treatment. As an example, a clinical observation of the successful use of a free bone autograft with an included skin pad is given. The use of this method during reconstructive operations reduces the number of postoperative complications.

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About the authors

E. V. Kryukov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

заслуженный врач РФ, академик РАН, профессор, генерал-лейтенант медицинской службы

Russian Federation, St. Petersburg

B. N. Kotiv

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

профессор, генерал-майор медицинской службы

Russian Federation, St. Petersburg

V. Yu. Markevich

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

доцент, полковник медицинской службы

Russian Federation, St. Petersburg

G. A. Grebnev

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: grebnev06@rambler.ru

заслуженный врач РФ, профессор, полковник медицинской службы запаса 

Russian Federation, St. Petersburg

I. M. Samokhvalov

The N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

заслуженный врач РФ, профессор, полковник медицинской службы запаса

Russian Federation, Moscow

S. V. Tereshchuk

The N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

доцент

Russian Federation, Moscow

V. A. Sukharev

The N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru
Russian Federation, Moscow

A. S. Bagnenko

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru

доцент, подполковник медицинской службы

Russian Federation, St. Petersburg

S. A. Morozov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: grebnev06@rambler.ru
Russian Federation, St. Petersburg

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Patient's view after eruption of the reconstructive plate: a - erupted plate; b - fistula with purulent discharge; c - scarring in the tongue area

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3. Fig. 2. Apparatus for extra-axial osteosynthesis installed

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4. Fig. 3. Percutaneous gastrostomy applied

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5. Fig. 4. Initial flaw of the mandible

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6. Fig. 5. Stages of 3D planning of reconstructive surgery

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7. Fig. 6. Flap marking

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8. Fig. 7. Composite perforator flap isolated and prepared for osteotomy

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9. Fig. 8. Template fixation on the fibula and osteotomy

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10. Fig. 9. View of the template fixed to the fibula at the SD-planning stage

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11. Fig. 10. After osteotomy, the peroneal flap is fixed with miniscrews to the plate

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12. Fig. 11. The flap is included into the bloodstream of the recipient area and fixed to the mandibular branches with a customized titanium plate

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13. Fig. 12. Postoperative patient's view: facial contour restored

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14. Fig. 13. Control CT with three-dimensional reconstruction

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15. Fig. 14. View of the patient on the 14th day after surgery

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Copyright (c) 2023 Kryukov E.V., Kotiv B.N., Markevich V.Y., Grebnev G.A., Samokhvalov I.M., Tereshchuk S.V., Sukharev V.A., Bagnenko A.S., Morozov S.A.


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