{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:11:47Z","timestamp":1760145107564,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T00:00:00Z","timestamp":1718841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.<\/jats:p>","DOI":"10.3390\/jcm13123613","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T11:42:03Z","timestamp":1718883723000},"page":"3613","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction\u2014A Case Series"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2302-7279","authenticated-orcid":false,"given":"Christoph","family":"Steiner","sequence":"first","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Neubert","sequence":"additional","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian B.","family":"Bottini","sequence":"additional","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5885-9529","authenticated-orcid":false,"given":"Shinnosuke","family":"Nogami","sequence":"additional","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"},{"name":"Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2569-6898","authenticated-orcid":false,"given":"Katharina","family":"Zeman-Kuhnert","sequence":"additional","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Gaggl","sequence":"additional","affiliation":[{"name":"Department of Oral and Craniomaxillofacial Surgery, Paracelsus Medical University Salzburg, M\u00fcllner Hauptstra\u00dfe 48, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/MOO.0000000000000282","article-title":"Temporomandibular joint reconstruction","volume":"24","author":"Imola","year":"2016","journal-title":"Curr. Opin. Otolaryngol. Head. Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1054\/ijom.2002.0447","article-title":"Principles for the revision of total alloplastic TMJ prostheses","volume":"32","author":"Mercuri","year":"2003","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1016\/j.joms.2012.06.174","article-title":"Avoiding and managing temporomandibular joint total joint replacement surgical site infections","volume":"70","author":"Mercuri","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2810","DOI":"10.1016\/j.joms.2010.05.089","article-title":"Management of the infected temporomandibular joint total joint prosthesis","volume":"68","author":"Wolford","year":"2010","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/j.bjps.2015.04.028","article-title":"Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla","volume":"68","author":"Grinsell","year":"2015","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.ijom.2017.12.002","article-title":"Reconstruction of the mandibular condyle using the microvascular lateral femoral condyle flap","volume":"47","author":"Enzinger","year":"2018","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_7","first-page":"371","article-title":"The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. North American orthopaedic rehabilitation research network","volume":"79","author":"Binkley","year":"1999","journal-title":"Phys. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.ijom.2020.09.017","article-title":"Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: A case series","volume":"50","author":"Xia","year":"2021","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) for Clinical and Research Applications: Recommendations of the International RDC\/TMD Consortium Network* and Orofacial Pain Special Interest Group\u2020","volume":"28","author":"Schiffman","year":"2014","journal-title":"J. Oral. Facial Pain. Headache"},{"key":"ref_10","first-page":"e43","article-title":"A review of scar scales and scar measuring devices","volume":"10","author":"Fearmonti","year":"2010","journal-title":"EPlasty"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00000637-199108000-00006","article-title":"Simultaneous transposition of anterior thigh muscle and fascia flaps: An introduction to the chimera flap principle","volume":"27","author":"Hallock","year":"1991","journal-title":"Ann. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/SAP.0000000000000884","article-title":"The chimera flap: A quarter century odyssey","volume":"78","author":"Hallock","year":"2017","journal-title":"Ann. Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1016\/j.jhsa.2015.06.106","article-title":"Lateral femoral condyle flap: An alternative source of vascularized bone from the distal femur","volume":"40","author":"Wong","year":"2015","journal-title":"J. Hand Surg. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.ijom.2018.07.018","article-title":"Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: A retrospective investigation","volume":"48","author":"Xia","year":"2019","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S0901-5027(05)80046-3","article-title":"Costochondral graft construction\/reconstruction of the ramus\/condyle unit: Long-term follow-up","volume":"23 Pt 1","author":"Perrott","year":"1994","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jormas.2017.10.007","article-title":"Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults","volume":"119","author":"Merlet","year":"2018","journal-title":"J. Stomatol. Oral. Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1024e","DOI":"10.1097\/PRS.0000000000002182","article-title":"Anatomy of the vascularized lateral femoral condyle flap","volume":"137","author":"Parvizi","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.bjps.2017.08.012","article-title":"Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection","volume":"71","author":"Morsy","year":"2018","journal-title":"J. Plast. Reconstr. Aesthet. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3613\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:01:38Z","timestamp":1760108498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,20]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123613"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123613","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,6,20]]}}}