Chapter 15. Reconstructive Surgery of the Face and Jaws (V.N. Bogatov, S.N. Lebedev)
5 topics with brief reviews: definitions, key facts, and class questions.
Chapter 15 is dedicated to reconstructive maxillofacial surgery, one of the most challenging and creative fields of our specialty. Here, we analyze the basic principles of correcting defects and deformities, restoring lost functions and aesthetics to patients.
The section consistently covers all key reconstruction techniques. We will study local skin plasty, the principles of forming and transferring pediciled flaps, as well as the microsurgical nuances of free tissue transplantation. A separate module focuses on jaw bone grafting, the foundation for restoring the facial skeletal framework after severe trauma, osteomyelitis, or oncological resections.
During practical classes and examinations, special emphasis is placed on tissue biomechanics. You will certainly be asked about planning local tissue plasty (for example, with Limberg transposition flaps), criteria for pedicle flap viability, and the mechanisms of free bone autograft engraftment. Study this material carefully—it is the absolute foundation for your future independent work in the operating room.
Why cannot functional surgeries in children be delayed until adulthood?
Functional impairment (respiration, mastication) in a child inevitably leads to abnormal anatomical development of the organ and the entire facial skeleton. These must be corrected as early as possible.
How does free transplantation differ from tubed pedicle plasty?
A free graft is completely severed from its donor site and loses its vascular connections. A pedicle flap is always nourished by the body via the pedicle at all stages of migration.
Why is the "plug" technique used in Filatov tubed pedicle plasty?
Implanting the end of the pedicle with preserved adipose tissue into the recipient bed securely closes the cavity. This reduces the risk of blood accumulation (hematoma) and accelerates neoangiogenesis.
Why is free bone grafting of the jaws avoided in oncology?
Due to previous radiation therapy and concomitant fibrosis, the recipient bed is in an unsatisfactory condition. This impairs the blood supply to the transplanted tissue and leads to necrosis.
Why is the entire rib not used for autoplasty?
Harvesting a full-thickness rib is not recommended due to the high probability of pleural injury. This can lead to a severe complication: pneumothorax. Therefore, only the outer cortical plate is excised for grafting.
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