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Master Thesis

Les vaisseaux receveurs des lambeaux libres dans le cas des déserts vasculaires : étude des vaisseaux thoraciques internes en cas de reconstruction mandibulaire par lambeau libre de fibula

Abstract : In maxillofacial microsurgical reconstruction, the most frequently used recipient vessels are the branches of the external carotid artery and the tributaries of the internal jugular vein. Difficulty in finding recipient vessels may occur in patients with a history of radiotherapy or with multi-operated neck. It is then necessary to use other recipient vessels, ideally close to the reconstruction site and out of the irradiated area: superficial temporal vessels, transverse cervical vessels, thoracoacromial vessels, cephalic vein. Surgical techniques such as venous bypass or arteriovenous loop may help to achieve successful anastomosis when recipient vessels are too far from the reconstruction site, but the risk of thrombosis is increased. An anatomical study about the transposition to the neck of the internal thoracic artery showed that a maxillofacial surgeon could perform the harvesting technique, by removing ribs segments. When the internal thoracic artery was harvested down to the fifth intercostal space, it reached the hyoid bone level and could allow anastomosis with the artery of a fibular flap without venous bypass (in the case of mandibular reconstruction). These results are to be confirmed by dissections on a larger number of subjects. Postoperative pain and scarring ransom are quite significant, but this technique is intended for patients with no other therapeutic alternatives. Robot-assisted harvesting of the internal thoracic artery is currently under development in cardiac surgery and may reduce these adverse effects, but it requires an important learning curve.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02505235
Contributor : Université Paris Descartes - Scd <>
Submitted on : Monday, February 8, 2021 - 4:34:18 PM
Last modification on : Saturday, February 13, 2021 - 3:18:44 AM

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  • HAL Id : dumas-02505235, version 1

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Suzanne Decaudaveine. Les vaisseaux receveurs des lambeaux libres dans le cas des déserts vasculaires : étude des vaisseaux thoraciques internes en cas de reconstruction mandibulaire par lambeau libre de fibula. Médecine humaine et pathologie. 2019. ⟨dumas-02505235⟩

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