Roy Andrée-Anne, Efanov Johnny I, Mercier-Couture Geneviève, Chollet André, Borsuk Daniel E
Plastic and Reconstructive Surgery, University of Montreal, Montreal, Quebec, Canada; and Division of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Plast Reconstr Surg Glob Open. 2017 Feb 3;5(2):e1226. doi: 10.1097/GOX.0000000000001226. eCollection 2017 Feb.
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient's unaffected side to allow for perfect fit to the zygomatico-maxillary defect. An intraoral dissection of the facial artery and vein was performed within the right cheek mucosa and allowed for end-to-end microvascular anastomoses. 3D preoperative planning and customized free DCIA osseous flap combined with an intraoral microsurgical technique provided restoration of facial esthetics and function without visible scars. In cases where zygomatico-malar reconstruction by alloplastic material fails, a customized free DCIA osseous flap can be designed by virtual surgical planning to restore facial appearance and function.
使用虚拟手术规划、计算机辅助制造和新的显微外科技术进行颅颌面重建，可优化针对患者个体和缺损的重建。对一名23岁男性患者进行了3D定制的带口腔内吻合的旋髂深动脉（DCIA）游离皮瓣手术，该患者因创伤后右侧颧骨-上颌骨缺损，异体植入物重建失败。根据患者未受影响侧镜像的定制3D模型雕刻髂骨嵴皮瓣，以使其与颧骨-上颌骨缺损完美贴合。在右侧颊黏膜内进行面动脉和静脉的口腔内解剖，并进行端对端微血管吻合。术前3D规划和定制的游离DCIA骨皮瓣结合口腔内显微外科技术，实现了面部美学和功能的恢复，且无明显疤痕。在异体材料进行颧骨-颧弓重建失败的病例中，可通过虚拟手术规划设计定制的游离DCIA骨皮瓣，以恢复面部外观和功能。
