Managing the Morbidity Related to Flap Reconstruction in Major Maxillofacial Oncology Surgery

There is substantial systemic and local morbidity associated with complex reconstruction of the maxillofacial (face, mouth, jaws and neck) region and the distant donor site of the free flap used to reconstruct the defect. This morbidity may be alleviated by careful patient preparation, selection of operation, improving wound care and new surgical procedures. Many aspects of morbidity are not readily amenable to investigation because of a multitude of confounding clinical factors. Improvements in the quality of care may be obtained by careful evaluation of outcomes and comparison with the literature. This body of work represents a reflection on my surgical practice, animal experimental studies and computer modelling techniques which have reduced morbidity and improved my ability to counsel patients. Major elements include the techniques of suprafascial dissection of the soft tissue radial flap and prophylactic internal fixation of the osteocutaneous radial donor site which have become increasingly accepted within the United Kingdom and overseas. The impact of differing flap choice, particularly in the medically compromised group, has been considered. The quality of the clinical documentation has been improved. Biomechanical issues raised by the clinical studies were investigated in laboratory work using the sheep tibia model of the human radius. A computer based model of the sheep tibia, created using a finite element analysis technique, was validated against the preceding biomechanical studies. This simulation was used to investigate the most effective design of osteotomy cuts and type of plate for reinforcement of a straight osteotomised bone, such as the radius, or segmental defects of the mandible. Interest in my work is reflected in the high rate of presentations at the Annual Scientific Meetings of the British Association of Oral & Maxillofacial Surgery combined with the joint second highest rate of successful conversion to publication in the United Kingdom.