BACKGROUND: Reconstruction of mandibular defects caused by combat injuries is challenging for clinicians due to soft tissue defects and high complication risk. This study evaluated the outcomes of mandibular continuous defects reconstruction with non-vascularized iliac crest graft (NVICG) in patients with combat injuries.
METHODS: Patients with continuous mandibular defects acquired by high-velocity agents, who received NVICG reconstruction with or without microvascular-free soft tissue or regional flaps, were included in the study. The outcome variable was graft loss due to postoperative complications or full (more than 90 %) resorption. The primary predictor variable was soft tissue defect in the recipient area. The secondary predictor variable was the length of the defect. Variables related to patients, defect site, surgery, and other complications were also evaluated. Statistical analysis was performed with the usage of independent sample t-test, Pearson\'s chi-squared and Fisher\'s exact tests with a significance level of P < 0.05 RESULTS: The study included 24 patients with 27 mandibular defects. Overall, the general success rate of reconstructions was 59.3 %. Soft tissue defects were significantly associated with graft failure and other complications (p < 0.05), which were mostly related to soft tissue defects. The graft success rate was only 14.3 % even in minor soft tissue defects. In turn, in reconstructions with sufficient soft tissue coverage, the graft survived in 75.0 % of the cases. In addition, patients with more delayed reconstruction had significantly fewer graft failures than those with earlier surgery (p < 0.05). No associations were found between defect size and complications.
CONCLUSIONS: The sufficient soft tissue coverage is essential in the reconstruction of mandibular defects caused by combat injuries. Also, minor soft tissue defects should be covered with soft tissue flaps to avoid complications and graft loss in these specific injuries. Even large defects can be reconstructed with NIVICG if the soft tissue coverage is sufficient.

BACKGROUND: Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery.
METHODS: 15 free flaps were performed in different patients in our center. Infrared-based lymphography was used to plan surgery. Indocyanine green (ICG) was injected in the flap\'s subdermal tissue and also at the edges of the skin defect. Circumferential lymphatic channels were marked 5 min after the ICG injection. Fluorescent images were recorded with an infrared camera system. The flap inset was obtained by putting side to side the flap markings and the recipient site markings. Infrared-based lymphography was performed on every patient one year after surgery. Spontaneous lymph flow restoration was judged positive if lymphatic connections were observed between the flap and the recipient site.
RESULTS: seven free ALT and eight DIEP flaps were performed. All ALT flaps were designed following the limb axis which is the lymphatic axiality. Spontaneous lymph flow restoration was observed for the seven ALT flaps. Eight DIEP flaps were designed upside down and one was designed following the lymph axiality. Spontaneous lymph flow restoration was only observed for the one designed following the lymph axiality.
CONCLUSIONS: designing reconstructive free flap regarding lymph axiality seems to improve spontaneous lymph flow restoration between flap and recipient site without any specific lymphatic surgery.

BACKGROUND: The anterolateral thigh (ALT) flap has become the universal workhorse for Head and Neck reconstruction. Being a perforator-based flap, accurate planning by preoperative perforator localisation is clearly beneficial. Acoustic Doppler (AD) and Colour Duplex Ultrasound (CDU) are the most practicable methods of localisation available. We designed a prospective study to analyse the correlation between preoperative localisation (by AD and CDU) and intraoperative findings, factoring in the advantages of using a high frequency probe for CDU.
METHODS: Thirty-three consecutive patients were analysed in a prospective, observational study. AD was first used to mark the perforator point and its distance measured from two anatomical landmarks, the Anterior Superior Iliac Spine (ASIS) and the \'Reference line\' (a line joining ASIS with the superior patellar border). CDU was then carried out to mark the perforator position with two probes (9 and 14 MHz), and the above distances measured for both points. At surgery, the actual point of perforator entry was separately marked and the same two distances were measured. A note was also made of perforator characteristics such as size and flow rate.
RESULTS: In 21/33 cases, there was a close concordance between pre- and intraoperative localisation (complete success). From the remaining 12 cases, the complete absence of perforator was found in one case, a small, unreliable perforator in 2 cases and a site disparity of > 2 cm between true and preop points in 9 cases.
CONCLUSIONS: No significant advantages were found with either a high frequency probe or indeed for CDU over AD. AD is sufficient for effective perforator localisation and should be routinely employed to accurately plan the anterior incision. CDU can be employed in cases where AD is unconvincing.