A move away from bony free flaps in reconstruction
Reviewed by Stuart Burrows

Techniques for facial reconstruction have come on in leaps and bounds since the world wars. The use of titanium implants is more recent and the technology for manipulating the metal and how we use it is rapidly developing. Here the next step is demonstrated by using titanium mesh as a support for particulate bone rather than a plate to hold a bone flap in place. The paper describes the premade titanium mesh basket holding the particulate cancellous bone in situ. The results suggest that the mesh allows the formation of a better facial contour as there are not the limitations of shaping a bony free flap and the rate of new bone formation was good. The key to the technique seems to be the pre-op planning and manufacturing of the mesh through 3D modelling. They did experience 2 titanium mesh fractures however modification of the manufacturing by double lining the mesh may have resolved this issue. In a world where we are not only trying to cure disease but optimise quality of life by the reconstructive techniques used this offers another method to reduce the deformity in facial surgery.

Clinical usefulness of mandibular reconstruction using custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow harvested from tibia and/or ilia.
Yamada H, Nakaoka K, Sonoyama T, et al.
THE JOURNAL OF CRANIOFACIAL SURGERY
2016;27(3):586-92.