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Big craniofacial resections for highly invasive malignant neoplasm, including skull base and maxillary bones, always represent a difficult chance for the reconstructive surgeon. In these cases it is not easy to restore anatomy and function simultaneously even adopting complex microsurgical techniques. In maxillofacial and oral surgery, simple bone homotransplantation for small bone segments reconstruction has been developing as popular technique and tissue banks offer not only bone segments but also many different tissues including complex body parts. In this paper we present, a case report of a homotransplantation of a complete temporomandibular joint (TMJ) together with a portion of the medial skull base and mandibular ramus folded with an ante-brachial fascio-periosteal free flap as secondary reconstruction after nearly 5 years from the removal of a sarcoma of the TMJ involving the skull base and a follow up of more than 30 months.

The middle third defects of the face following total or partial oncologic maxillectomy include very important facial structures, both for esthetical and for functional reasons. Among the outcomes, large oronasal or oromaxillary fistulas due to destruction of big bone segments and soft tissues have long been the consequences of such extensive surgical ablations. In the last few years, immediate reconstruction of maxillary bones and soft tissues has proved to be a reliable morphofunctional reconstruction technique following surgery for large oncological defects or the late effects of radiation therapy. Among other free flaps such as composite fibula, composite scapula, or composite radial, the use of vascularized iliac crest with the internal oblique flap has become our flap choice for morphofunctional maxillary reconstruction for bone segments within 6-15 cm of length, and when there is no need for overlying facial skin or oral sphincter reconstruction. The advantages of this composite bone flap are its available large and resizable bone stock; the quality of the bone for transfer (optimal height, depth, and contour to maintain a good facial profile); and the possibility to properly reconstruct the oral lining, orbital content; and maxillary soft tissues with a portion of the internal oblique muscle flap raised with the same pedicle. In addition, this flap's soft tissue will epithelialize during the healing stages., ((c) 2007 Wiley-Liss, Inc.)

The distal lateral arm flap (DLAF) was used to reconstruct six extensive defects of the digits: 2 degloving injuries of the thumb and 4 major skin losses of the fingers. Two adjacent fingers were involved in 1 patient. Flap size ranged from 3 x 7 cm to 9 x 14 cm. Four flaps were reinnervated using the posterior cutaneous nerve of the forearm. All flaps survived, though 1 showed marginal necrosis. Average follow-up was 53.4 months. Thumb opposition scored 5 according to Kapandji; finger ROM averaged 50.75%; pinch strength 72.5%. Protective sensation with touch localization was restored. Patient satisfaction for resurfaced digits averaged 8.9 on a 10-points visual analogic scale. All donor sites resulted in a painless scar with good patient satisfaction. The DLAF offers a thin, pliable skin ideal for digit reconstruction, with low rate of donor site morbidity and can be considered when toe-to-hand flap transfer is not advisable or refused by the patient., ((c) 2007 Wiley-Liss, Inc.)

This study reports on the long-term functional outcomes of a homogeneous series of 10 cases of successful replantation of an avulsed proximal forearm and its acceptance on the part of patients. After a minimum follow-up of 3 years (average, 4.7 years), muscular and sensory recovery was evaluated with the Medical Research Council scale, and global function according to the demerit score system of Chen (China Med 5:392-397, 1967). Subjective evaluation and patient satisfaction were investigated by means of a questionnaire. One patient was classified as grade 2, 4 patients as grade 3, and 5 patients as grade 4 according to Chen (China Med 5:392-397, 1967). However, in spite of the poor objective results, patient satisfaction was obtained in 90% of cases, and the replanted extremity was considered of help for common activities of daily living. In conclusion, replantation of an avulsed proximal forearm should be considered only in patients who are strongly motivated to maintain body integrity, and who are aware of the expected functional limitations., (Copyright 2005 Wiley-Liss, Inc.)