Reconstructive Options and Outcomes in Primary vs. Secondary Mandibular Reconstruction
Notice bibliographique
Résumé
The challenge of mandibular reconstruction is potentially increased in secondary reconstructive procedures as a result of scarring, wound bed contamination, and the greater likelihood of prior radiotherapy. Recipient vessels for microanastomosis may be more likely to be obliterated or encased in scar tissue. However, few reports have attempted to compare reconstructive options and their outcomes with respect to primary vs. secondary mandibular reconstruction. The authors' hypothesis was that factors specific to secondary mandibular reconstruction may increase the risk of flap failure and other postoperative complications, compared with primary reconstruction. A retrospective chart review was performed on 110 patients who underwent primary mandibular reconstruction and 39 patients who received secondary reconstruction. The demographic and past medical history of the patients was well-matched; there was no statistically significant difference in patient age, therapy, or chemotherapy. However the mandibular defects of the secondary reconstruction group were larger in size and more challenging in location, with a significantly higher (p =ߙ0.018) proportion of secondary defects involving the condyle (12.8% vs. 6.4%) or the central portion of the mandible (15.4% vs. 2.6%). The greater diversity of defects was reflected by a significantly higher (p =ߙ0.03) use of non-fibula osseous free flaps to reconstruct secondary defects, although the vascularized fibular flap was the most common flap used in both primary (80%) and secondary (69%) reconstructions. Despite the additional complexity of secondary reconstruction, the complication rates were surprisingly similar. There was no significant difference in the number of patients who experienced one or more complications. The primary reconstruction group had a higher proportion of early complications such as partial or total flap loss that required additional surgery than those who underwent secondary reconstruction (28.2% vs. 20.5%). Late complications such as plate fracture or osteoradionecrosis were more common in the secondary group (28.2% vs. 17.3%). Despite more challenging defects and scarred operative fields in secondary mandibular reconstruction, compared to primary reconstruction, success can be achieved utilizing a broader repertoire of osseous free flaps. Preoperative radiation therapy does not appear to have an effect on outcome. Early complications, including flap loss, actually occur less frequently in the secondary reconstruction, but success in long-term survivors is compromised by later complications.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».