Digital Assisted Chimeric Deep Circumflex Iliac Artery Perforator Flap In The Reconstruction Of Mandibular Composite Defects

Objective: To evaluate the clinical effect of digital assisted chimeric deep circumflex iliac artery perforator flap in the reconstruction of mandibular composite defects.Methods: From January 2018 to October 2019,seven patients with mandibular defect after tumor surgery were evaluated by CTA and CDU before surgery,digital software and 3D printing technology were used to simulate vascularized bone flap harvesting,design and manufacture osteotomy guide plate and in-situ guide plate,and simulate the effect of reconstruction and repair,one group of doctors was responsible for neck lymph node dissection,vessel preparation and focus resection in the recipient area,and the other group of doctors performed DCIAPF preparation,pedicle cutting and cosmetic suture in the donor area,and finally anastomosed the vessels of the chimeric flap with recipient area vessels under the microscope,according to the preoperative design,the flap was placed in the defect area,aligned the broken end of the bone,and fixd with titanium preform plate and mandible.Close the wound inside and outside the mouth and neck.After 3~6months follow-up,the patients were examined by panoramic and cone-beam CT to evaluate the facial appearance,jaw height,occlusal function and donor site complications.Results: Ameloblastoma in 2 cases,5 cases of gingival cancer.Cut out ilium up to 13 cm,the shortest was 6 cm,carrying the flap area of up to 30 cm squared,minimum 3cm squared 6 cases of deep circumflex iliac artery perforator flap and iliac bone flap survived.One case changed plan,we used iliac bone flap combined with superficial circumflex iliac artery perforator flap to repair mandibular defect.The shape,mandibular height and occlusal function of the 7 patiens were satisfactiory after operation,and no obvious complications were found in the donor area.Conclusion: The chimeric deep circumflex iliac artery perforator flaps blood supply is rich,bone mass is enough,enough bone height,terminal skin perforators is constant,only need to match a set of maternal blood vessels,combined with the digital technology can realize the accuracy of mandibular defect repair and the three-dimensional wound repair,late for even the same line of dental implant repair provides an advantageous condition,and less complications for the area,is one of the ideal method of reconstruction of mandibular defect.