Background and objectives : Conventional maxillofacial reconstruction often leads to suboptimal results due to inaccurate planning or surgical difficulties in adjusting a free flap into a three-dimensional defect. Conversely, flap prefabrication together with precise preoperative planning enables an optimal flap design such that a prosthetically ideal implant-supported rehabilitation is possible. The aim of this abstract is to present our 14-year experience with prefabrication and to justify this treatment concept.
Patients and methods : A retrospective analysis of all patients who underwent a prefabrication protocol for maxillofacial reconstruction was performed. This protocol involves an initial surgical stage, namely “flap prefabrication”, where dental implants are inserted at the donor site and the future mucosa is created with a split-thickness skin graft. After 6–8 weeks, the graft is harvested, the donor bone is osteotomized and adjusted to a preprepared provisional prosthesis, and the flap-prosthesis complex is transferred to the defect.
Results : Since 1999, a total of 54 flaps have been transferred following our prefabrication concept. In 51 cases, the fibula was the preferred donor site. In the remaining 3, other donor sites were used (2 iliac crest, 1 scapula). In 30 patients a maxillary reconstruction was performed, whereas in the other 24 a mandibular reconstruction was executed. Four flaps were lost partially and 3 were lost completely. A total of 208 implants were placed. Of these, 14 were lost at an early stage, and 12 showed delayed failure. Patients regained full function and aesthetics within 6–10 weeks.
Conclusions : Compared to conventional planning, prefabrication ensures an optimal position of the flap that enables prosthetically ideal implant placement. The future gingiva is prefabricated and incorporated into the flap, thus sparing the patient from secondary multistage soft tissue procedures prior to prosthetic rehabilitation. In addition, operating room time, ischemia time and handling trauma to the graft are reduced.