Extending the Cordeiro Maxillofacial Defect Classification System for Use in the Era of Vascularized Composite Transplantation
Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA.Plastic and Reconstructive Surgery (Impact Factor: 2.99). 08/2012; 130(2):419-22. DOI: 10.1097/PRS.0b013e3182589ec6
There is a growing interest in the use of vascularized composite transplantation to reconstruct major facial and craniofacial deformities. This phenomenon is driven both by the success of recent transplantations to functionally and aesthetically restore patients and by an increase in the number of centers entering this challenging field. The authors' new classification system, based on a well-established schema, allows proper documentation of the needs of these patients and enhancement of interinstitutional communication for outcomes reporting.
- "Number of free flaps will be certainly much higher. Tissue allotransplant are being already performed. Robotic surgery in progress. "
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ABSTRACT: Whatever is excisable, is reconstructable! "You excise, we will reconstruct" are the confident words of reconstructive surgeons today. Reconstruction with multiple flaps has become routine. Radial artery (FRAF), Antero lateral thigh (ALT) and Fibula osteo cutaneous flap (FFOCF) are three most popular free flaps which can reconstruct any defect with excellent asthetics and performance. Radial Artery provides thin, pliable innervated skin; ALT large amount of skin & bulk; and FFOCF strong 22 to 25 centimetres of bone and reliable skin paddle. Free flap survival has gone to 98% in most of the renouned institutes and is an established escalator in management of defects.
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ABSTRACT: As of July of 2013, 27 facial vascularized composite allotransplantations have been performed. The authors developed a classification system and treatment algorithm that is practical and surgically applicable. The majority of the transplants have been described in the surgical literature and the media, and a review of the data was performed. A classification system and a treatment algorithm were designed. Skeletal defects were defined by craniofacial osteotomies and soft-tissue defects by aesthetic facial subunits. The soft-tissue defect was subdivided into the following subunits: oral-nasal (type 1), oronasal-orbital (type 2), and full facial (type 3). The bony defects were subdivided into mandibular involvement (M), Le Fort 1 (A), Le Fort 3 (B), and monobloc (C). The mechanisms of injury included trauma (n = 13), burns (n = 8), congenital deformity (n = 3), oncologic resection (n = 1), and unreported (n = 2). According to the proposed classification system: one was type 1; one was type 1-M; one was type 1-MB; two were type 2; two were type 2-B; two were type 2-MB; six were type 3; one was type 3-B; and three were type 3-MB; eight could not be classified due to a lack of data. The treatment algorithm designed a vascularized composite allotransplantation that addressed the bony and soft-tissue components. Patient selection for these complicated procedures, currently dependent on lifelong immunosuppression, is crucial to their success. The authors describe a classification system and treatment algorithm for facial defects that may be ideally suited for facial transplantation. The proposed classification and algorithm may help centers define indications and ideally improve patient outcomes. Therapeutic, V.
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