Knudson Sean A, Day Kristopher M, Kelley Patrick, Padilla Pablo, Collier Ian X, Henry Steven, Harshbarger Raymond, Combs Patrick
Division of Craniofacial and Pediatric Plastic Surgery, Dell Children's Medical Center, The University of Texas at Austin, Austin, TX, USA.
Department of Plastic Surgery, Dell Seton Medical Center, The University of Texas at Austin, Austin, TX, USA.
Craniomaxillofac Trauma Reconstr. 2022 Sep;15(3):206-218. doi: 10.1177/19433875211026432. Epub 2021 Jun 21.
Retrospective case series; systematic review.
It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion.
A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis.
Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline.
Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.
回顾性病例系列研究；系统评价。
急性颌面弹道伤（MBT）后，使用虚拟手术规划（VSP）辅助同期进行下颌骨显微外科重建是否足以实现确定性重建和功能性咬合尚不清楚。
对急性MBT后使用VSP进行下颌骨显微外科重建的患者进行单中心回顾性分析。使用盲法筛选对PubMed/MEDLINE、Embase、ScienceDirect和Scopus数据库进行系统评价。通过主题分析对研究进行评估。
5例患者在同期接受了使用VSP的下颌骨显微外科重建。我们观察到从初次就诊到重建的平均时间为16.4±9.1天，平均住院时间为51.6±17.9天，每位患者平均手术6.2±2.8次，游离皮瓣1.6±0.9个。共使用了4种类型的8个皮瓣，最常用的是股前外侧皮瓣（37.5%）。护理使皮瓣全部存活。每位患者至少经历1次轻微并发症。所有患者均实现了正中咬合、经口营养，并面部美学接近基线水平。随访时间为191.0±183.9周。系统评价产生了8篇符合纳入标准的文章。在MBT重建实践中，文献中关于VSP的临床目标和功能存在共识主题，但在最佳治疗时间方面存在分歧。
MBT后同期进行显微外科重建对于重建下颌骨形态和功能是安全有效的。鉴于确定性重建前需要进行准备，VSP并未延迟重建。
