CLINICAL DECISIONS IN MANDIBULAR RECONSTRUCTION AFTER GUNSHOT INJURY

Abstract

The problem of treating gunshot injuries of the lower third of the face remains relevant since bone and soft tissue defects negatively affect not only daily life but also psychosocial health.Objective. To present the navigation of mandibular reconstruction using a free fibular autograft in patients with gunshot injuries (clinical cases) and the work of an interdisciplinary team to improve outcomes.Materials and Methods. Using three selected cases, the course of surgery and interdisciplinary communication were reviewed.Patients underwent total mandibular reconstruction using a free hard and soft tissue fibular autograft with vascular pedicle and anastomosis to neck vessels.Results. During the study, the surgical course was analyzed and important stages of mandibular reconstruction using a free fibular autograft were formulated:1. Restoration of the mandibular contour using reconstructive titanium plates (the bone is exposed and mandibular fragments are resected according to the preoperative surgical plan); 2. Creation of a template to be used for modeling the fibular flap (it is necessary to consider the length, number, orientation of fibular segments, and the possibility of performing osteotomies to account for plate curvature); 3. Contouring of the fibular bone (marking the incision and future flap shape, the musculoskeletal free flap is separated from the donor site, and the fibula is resected according to the shape of the resection template); 4. Fixation of the flap in the recipient area (fitting the osteomusculocutaneous free autograft to the mandible, fixation to the individual implant with screws); 5. Formation of microvascular anastomoses (integration of the flap into the bloodstream). These steps must be performed following preoperative virtual surgical planning using 3D modeling.Conclusions. To achieve optimal outcomes in mandibular reconstruction, effective interdisciplinary communication is necessary. In mandibular reconstruction, the selection and isolation of appropriate recipient vessels for microvascular anastomosis are crucial. Modeling the template on the fibula bone should also be considered a key point for obtaining a satisfactory result.