posted on 2015-06-02, 15:35authored byChristopher Martin Edward Avery
There is substantial systemic and local morbidity associated with complex reconstruction
of the maxillofacial (face, mouth, jaws and neck) region and the distant donor site of the
free flap used to reconstruct the defect. This morbidity may be alleviated by careful patient
preparation, selection of operation, improving wound care and new surgical procedures.
Many aspects of morbidity are not readily amenable to investigation because of a multitude
of confounding clinical factors. Improvements in the quality of care may be obtained by
careful evaluation of outcomes and comparison with the literature. This body of work
represents a reflection on my surgical practice, animal experimental studies and computer
modelling techniques which have reduced morbidity and improved my ability to counsel
patients.
Major elements include the techniques of suprafascial dissection of the soft tissue radial
flap and prophylactic internal fixation of the osteocutaneous radial donor site which have
become increasingly accepted within the United Kingdom and overseas. The impact of
differing flap choice, particularly in the medically compromised group, has been
considered. The quality of the clinical documentation has been improved.
Biomechanical issues raised by the clinical studies were investigated in laboratory work
using the sheep tibia model of the human radius. A computer based model of the sheep
tibia, created using a finite element analysis technique, was validated against the preceding
biomechanical studies. This simulation was used to investigate the most effective design of
osteotomy cuts and type of plate for reinforcement of a straight osteotomised bone, such as
the radius, or segmental defects of the mandible.
Interest in my work is reflected in the high rate of presentations at the Annual Scientific
Meetings of the British Association of Oral & Maxillofacial Surgery combined with the
joint second highest rate of successful conversion to publication in the United Kingdom.
History
Supervisor(s)
Steward, W.
Date of award
2015-03-02
Author affiliation
Department of Cancer Studies & Molecular Medicine
Awarding institution
University of Leicester
Qualification level
Doctoral
Qualification name
MD
Notes
Thesis Submitted for the
Degree of Doctor of Medicine by Published Work
University of Leicester