Simultaneous mandible and zygomatic arch reconstruction with a single free fibula flap

Microsurgery ◽  
2021 ◽  
Author(s):  
Iván Heredia‐Alcalde ◽  
Ana Trapero ◽  
Belén Andresen‐Lorca ◽  
Alberto Pérez‐García
Keyword(s):  
Zygomatic Arch ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula ◽  
Arch Reconstruction

Long-Term Follow-Up of Total Penile Reconstruction with the Sensate Osteocutaneous Free Fibula Flap

2006 ◽  
Vol 22 (03) ◽  
Author(s):  
Mustafa Şengezer ◽  
Serdar Ozturk ◽  
Mustafa Deveci ◽  
Mustafa Nisanci
Keyword(s):  
Free Fibula Flap ◽  
Fibula Flap ◽  
Long Term Follow Up ◽  
Free Fibula

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

2021 ◽  
Author(s):  
Kuan-Ying Wang ◽  
Wen-Chung Liu ◽  
Chun-Feng Chen ◽  
Lee-Wei Chen ◽  
Hung-Chi Chen ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Muscle Flap ◽  
Flexor Hallucis Longus ◽  
Free Fibula Flap ◽  
Chi Square ◽  
Fibula Flap ◽  
Free Fibula ◽  
Chi Square Test

Abstract Background Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. Methods This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998–2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. Results Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). Conclusion Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

2020 ◽  
pp. 194338752098024
Author(s):  
Jorge Ernesto Cantini Ardila ◽  
Carlos Eduardo Torres Fuentes ◽  
Giovanni Montealegre Gomez ◽  
Susana Correa ◽  
Erika Paola Gutierrez ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Case Series ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Occlusal Splints ◽  
Fibula Flap ◽  
Case Series Study ◽  
Free Fibula ◽  
Cutting Guides ◽  
Series Study

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.

Preoperative Angiography for Free Fibula Flap Harvest: A Case Series: L’angiographie préopératoire pour prélever un lambeau libre de la fibula : une série de cas

2021 ◽  
pp. 229255032199696
Author(s):  
Noor Alolabi ◽  
Haley Augustine ◽  
Forough Farrokhyar ◽  
Carolyn Levis
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Perioperative Complications ◽  
Case Series ◽  
Vascular Anatomy ◽  
Limb Ischemia ◽  
Free Fibula Flap ◽  
Retrospective Case ◽  
Fibula Flap ◽  
Free Fibula

Purpose: To assess if preoperative angiography of the lower extremity is necessary to detect abnormalities that alter operative planning of a free fibula flap (FFF). The secondary objective is to determine whether abnormalities are identified on physical examination. Methods: A retrospective case series of patients receiving preoperative lower extremity angiography for FFF was performed. Between November 2004 and July 2016, patients assessed for FFF reconstruction by a single surgeon were reviewed. Outcomes analyzed were preoperative physical examination, angiography findings, changes in operative plan, and perioperative complications including flap failure and limb ischemia. Level of agreement between physical examination and angiography findings was analyzed. Results: A total of 132 consecutive patients were assessed for FFF, of which 70 met the inclusion criteria. Mean age was 60.9 (range: 22-88) years old. All patients underwent aortic angiogram runoff, except for 2 who received computed tomography angiography. The surgical plan was altered based on angiography findings in 9 (12.9%) patients, and 7 (77.8%) of these cases had a normal physical examination. A further 6 (8.6%) patients had physical examination findings precluding the use of FFF, whereas imaging demonstrated the contrary. Physical examination demonstrated low predictability of aberrant vascular anatomy, with a sensitivity of 22.2%. There were no limb ischemia complications. Conclusions: Routine preoperative angiography of the lower extremity for all patients being evaluated for FFF is important to ensure safety and success of the procedure. Physical examination alone is insufficient to detect vascular abnormalities that may result in limb or flap compromise.

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