Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction

2018 ◽  
Vol 41 (4) ◽  
pp. 447-454
Author(s):  
Lara Nokovitch ◽  
Julien Davrou ◽  
François Bidault ◽  
Bernard Devauchelle ◽  
Stéphanie Dakpé ◽  
...  
Keyword(s):  
Soleus Muscle ◽  
Vascular Anatomy ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula ◽  
Lateral Head

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.

scholarly journals How to harvest free fibula flap for mandibular reconstruction? Practical tips and tricks

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Chirom A Singh ◽  
Rajeev Kumar ◽  
Pirabu Sakthivel
Keyword(s):  
Mandibular Reconstruction ◽  
Tips And Tricks ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula

CAD-CAM vs conventional technique for mandibular reconstruction with free fibula flap: A comparison of outcomes

2020 ◽  
Vol 34 ◽  
pp. 284-291 ◽  
Author(s):  
Sanjay Mahendru ◽  
Rahul Jain ◽  
Aditya Aggarwal ◽  
Hardeep S. Aulakh ◽  
Ankit Jain ◽  
...  
Keyword(s):  
Conventional Technique ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Cad Cam ◽  
Free Fibula

Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap

Oral Oncology ◽  
2017 ◽  
Vol 75 ◽  
pp. 133-139 ◽  
Author(s):  
Tingwei Bao ◽  
Jianfeng He ◽  
Changyang Yu ◽  
Wenquan Zhao ◽  
Yi Lin ◽  
...  
Keyword(s):  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Surgical Guide ◽  
Fibula Flap ◽  
Free Fibula ◽  
Guide System ◽  
Bent Plate

Iliac crest inner table free flap vs free fibula flap for mandibular reconstruction

2013 ◽  
Vol 42 (10) ◽  
pp. 1298
Author(s):  
R. Sieira ◽  
C. Martí ◽  
E. García ◽  
A. Ferrer ◽  
J. Rubio
Keyword(s):  
Free Flap ◽  
Iliac Crest ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula

scholarly journals Mandibular Reconstruction with Free Fibula Flap for Medication-related Osteonecrosis of the Jaw in Patients with Multiple Myeloma

2020 ◽  
Vol 8 (10) ◽  
pp. e3186 ◽  
Author(s):  
Christodoulos Kaoutzanis ◽  
Jason W. Yu ◽  
Z-Hye Lee ◽  
Ashkan Davary ◽  
Kenneth E. Fleisher ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Osteonecrosis Of The Jaw ◽  
Mandibular Reconstruction ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula

scholarly journals Mandibular Reconstruction with Free Fibula Flap: Experience at Hayatabad Medical Complex, Peshawar

2019 ◽  
Vol 8 (4) ◽  
pp. 198-202
Author(s):  
Syed Asif Shah ◽  
Irfan Ullah ◽  
Muhammad Bilal ◽  
Mohammad Hamayun Shinwari ◽  
Adeeba Ahmad ◽  
...  
Keyword(s):  
Success Rate ◽  
Donor Site ◽  
Graft Loss ◽  
Tumor Resection ◽  
Mandibular Reconstruction ◽  
Diabetic Patients ◽  
Free Fibula Flap ◽  
Skin Paddle ◽  
Fibula Flap ◽  
Free Fibula

Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.

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