Executive Editor: Gregorio Sánchez Aniceto, Marcelo Figari General Editor: Daniel Buchbinder

Authors: Brian Burkey, Neal Futran

Postablative reconstruction

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Glossary

Basic treatment techniques

Anterolateral thigh
Pectoralis myocutaneous pedicle flap
Radial forearm fasciocutaneous flap
Scapula
Fibula osteocutaneous flap
Iliac crest
Rectus abdominis
Radial forearm

Anterior skull base without orbital involvement

Please select a treatment option:
Treatment Main indication Skill Equipment
Pericranial flap Anterior skull base without orbital involvement. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Anterior skull base without orbital involvement. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anterior skull base with orbital involvement

Please select a treatment option:
Treatment Main indication Skill Equipment
Pericranial and temporoparietal fascia flap Anterior skull base defect with orbital involvement. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm free flap Anterior skull base defect with orbital involvement when no local vascular tissues are available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterolateral thigh fasciocutaneous free flap Anterior skull base defect with orbital involvement when no local vascular tissues are available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Rectus abdominis fasciocutaneous free flap Anterior skull base defect with orbital involvement when no local vascular tissues are available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Latissimus dorsi fasciocutaneous free flap Anterior skull base defect with orbital involvement when no local vascular tissues are available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Cranial vault

Please select a treatment option:
Treatment Main indication Skill Equipment
Scalp flap Limited defects of the skull and cranium. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Larger defects of the skull and cranium. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Latissimus dorsi fasciocutaneous free flap Larger defects of the skull and cranium. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Brown I, palate

Please select a treatment option:
Treatment Main indication Skill Equipment
Obturator Brown class I horizontal defects or Brown class I vertical defects. Some specialized surgical experience Simple surgical and imaging resources
Palatal island flap Brown class I horizontal defects, but not Brown class I vertical defects. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Brown class I horizontal defects or Brown class I vertical defects. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Brown I, alveolus

Please select a treatment option:
Treatment Main indication Skill Equipment
Obturator Brown I alveolar defect. Some specialized surgical experience Simple surgical and imaging resources
Buccal fat pad Limited Brown I alveolar defect. Some specialized surgical experience Simple surgical and imaging resources
Temporalis muscle flap Brown I alveolar defect. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Temporoparietal fascia flap Brown I alveolar defect. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial forearm fasciocutaneous free flap Brown I alveolar defect when local tissue is insufficient. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Brown II

Please select a treatment option:
Treatment Main indication Skill Equipment
Obturator Brown II defect with good remaining dentition or edentulous patients with good retentive prostheses. Some specialized surgical experience Full specialized surgical and imaging resources
Temporalis muscle flap Brown II defect when functional dental restoration not indicated or desired. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Brown II defect when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterolateral thigh fasciocutaneous free flap Brown II defect when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Fibular osteocutaneous free flap Brown II defect when dental restoration is indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Scapular osteocutaneous free flap Brown II defect when dental restoration is indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial forearm osteocutaneous free flap Brown II defect when dental restoration is indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Midface reconstruction Complex Brown II defects when CA planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven maxillary reconstruction Complex Brown II defects when CA planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Brown III

Please select a treatment option:
Treatment Main indication Skill Equipment
Obturator Brown III defect functional dental restoration not indicated or desired. Some specialized surgical experience Simple surgical and imaging resources
Rectus abdominis fasciocutaneous free flap Brown III defect where local tissue is insufficient and functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterolateral thigh fasciocutaneous free flap Brown III defect where local tissue is insufficient and functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Iliac crest-internal oblique free flap Brown III defect where local tissue is insufficient and functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Scapular osteocutaneous free flap Brown III defect when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Midface reconstruction Complex Brown III defects when CA planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven maxillary reconstruction Complex Brown III defects when CA planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Brown IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Rectus abdominis fasciocutaneous free flap Brown IV defect when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterolateral thigh fasciocutaneous free flap Brown IV defect when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, mucosa, with or without tongue (smaller than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Primary closure Lateral mandible, mucosa, with or without tongue when patients' medical condition precludes extensive reconstruction. Some specialized surgical experience Simple surgical and imaging resources
Pectoralis major myocutaneous pedicle flap Lateral mandible, mucosa, with or without tongue when primary soft tissue repair is not possible. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial forearm fasciocutaneous free flap Lateral mandible, mucosa, with or without tongue when primary soft tissue repair is not possible. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and pectoralis major myocutaneous pedicle flap Lateral, mucosa, with or without tongue to prevent mandibular shift and perform soft tissue reconstruction. Some specialized surgical experience Simple surgical and imaging resources
Plate and radial forearm fasciocutaneous free flap Lateral mandible, with or without tongue to prevent mandibular shift and perform soft tissue reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and iliac crest-internal oblique free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, mucosa, tongue (larger than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Radial forearm fasciocutaneous free flap Lateral mandible, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and radial forearm fasciocutaneous free flap Lateral mandible, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Lateral mandible, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous with radial forearm free flap Lateral mandible, mucosa, and tongue when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible and skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Pectoralis major myocutaneous pedicle flap Composite defects when patients' medical condition precludes a more extensive reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial forearm fasciocutaneous free flap Composite defects when patients' medical condition precludes a more extensive reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and pectoralis major myocutaneous pedicle flap Lateral mandible and skin to prevent mandibular shift and perform soft tissue reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and radial forearm fasciocutaneous free flap Lateral mandible and skin to prevent mandibular shift and perform soft tissue reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, mucosa and skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Pectoralis major myocutaneous pedicle flap Lateral mandible, mucosa, and skin when patients' medical condition precludes a more extensive reconstruction. Some specialized surgical experience Simple surgical and imaging resources
Plate and pectoralis major myocutaneous pedicle flap Lateral mandible, mucosa, and skin to prevent mandibular shift and perform soft tissue reconstruction. Some specialized surgical experience Simple surgical and imaging resources
Plate and radial forearm fasciocutaneous free flap to prevent mandibular shift and perform soft tissue reconstruction. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and iliac crest internal oblique free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Critical size composite defects (>5cm) when functional dental restoration not indicated or desired. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, condyle, mucosa, with or without tongue (smaller than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Primary closure Lateral mandible, condyle, mucosa, with or without tongue. Some specialized surgical experience Basic equipment only
Pectoralis major myocutaneous pedicle flap Lateral mandible, condyle, mucosa, with or without tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial forearm fasciocutaneous free flap Lateral mandible, condyle, mucosa, with or without tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous free flap Lateral mandible, condyle, mucosa, with or without tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible, condyle, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible, condyle, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, condyle, mucosa, tongue (larger than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Radial forearm fasciocutaneous free flap Lateral mandible, condyle, mucosa, and tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Lateral mandible, condyle, mucosa, and tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous with radial forearm free flap Lateral mandible, condyle, mucosa, and tongue when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible, condyle, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible, condyle, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Lateral mandible, condyle, mucosa and skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Pectoralis major myocutaneous pedicle flap Lateral mandible, condyle, mucosa, and skin when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterolateral thigh fasciocutaneous free flap Lateral mandible, condyle, mucosa, and skin when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and iliac crest internal oblique free flap Lateral mandible, condyle, mucosa, and skin when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Lateral mandible, condyle, mucosa, and skin when patients' medical condition precludes a more extensive reconstruction and primary closure is not indicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Lateral mandible and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Lateral mandible and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Marginal mandible, inner cortical

Please select a treatment option:
Treatment Main indication Skill Equipment
Secondary intention Limited marginal, inner cortical. Some specialized surgical experience Basic equipment only
Skin graft Marginal, inner cortical. Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Limited marginal, inner cortical. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Marginal mandible, full thickness (double cortical)

Please select a treatment option:
Treatment Main indication Skill Equipment
Secondary intention Limited, marginal, full thickness (double cortical). Some specialized surgical experience Basic equipment only
Skin graft Marginal, full thickness (double cortical). Some specialized surgical experience Simple surgical and imaging resources
Radial forearm fasciocutaneous free flap Marginal, full thickness (double cortical) when local tissue or skin graft is insufficient in patients with previous radiation history. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, mucosa, with or without tongue (smaller than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and fibular osteocutaneous free flap Symphysis, mucosa, with or without tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Symphysis, mucosa, with or without tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and iliac crest-internal oblique free flap Symphysis, mucosa, with or without tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, mucosa, tongue (larger than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and scapular osteocutaneous free flap Symphysis, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and fibular osteocutaneous with radial forearm free flap Symphysis, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis and skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and fibular osteocutaneous free flap Symphysis and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Symphysis and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, mucosa and skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and iliac crest internal oblique free flap Symphysis, mucosa, and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Symphysis, mucosa, and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, condyle, mucosa, with or without tongue (smaller than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and fibular osteocutaneous free flap Symphysis, condyle, mucosa, with or without tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, condyle, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, condyle, mucosa, with or without tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, condyle, mucosa, tongue (larger than 1/3)

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and fibular osteocutaneous with radial forearm free flap Symphysis, condyle, mucosa, and tongue. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, condyle, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, condyle, mucosa, and tongue when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Symphysis, condyle, mucosa, skin

Please select a treatment option:
Treatment Main indication Skill Equipment
Plate and iliac crest internal oblique free flap Symphysis, condyle, mucosa, and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plate and scapular osteocutaneous free flap Symphysis, condyle, mucosa, and skin. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Mandibular reconstruction Symphysis, condyle, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
CAS: Prostodontic-driven mandibular reconstruction Symphysis, condyle, mucosa, and skin when virtual planning facilitates the procedure. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Computer assisted surgery
Mandibular reconstruction
Prostodontic-driven mandibular reconstruction
Prostodontic-driven maxillary reconstruction
Midface reconstruction
Tumor biopsy
Biopsy mapping
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2012-07-07