Functional Outcomes in Total Talus Reconstruction with Triangular Double Barrel Free Fibula Flap Following Oncological Resection: A Retrospective Case Series Review

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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Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520980246 ◽

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.

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Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000007095 ◽

2020 ◽

Vol 146 (3) ◽

pp. 650-662

Author(s):

Alexander F. Mericli ◽

Stefanos Boukovalas ◽

Margaret S. Roubaud ◽

Carrie Kai-Cheng Chu ◽

Justin Bird ◽

...

Keyword(s):

Functional Outcomes ◽

Union Rate ◽

Free Fibula Flap ◽

Fibula Flap ◽

Oncologic Resection ◽

Free Fibula

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Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up

Head & Face Medicine ◽

10.1186/s13005-021-00297-9 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Tamás Sass ◽

József Piffkó ◽

Gábor Braunitzer ◽

Ferenc Oberna

Keyword(s):

Clinical Status ◽

Case Series ◽

Vertical Dimension ◽

Free Fibula Flap ◽

Large Defect ◽

Fibula Flap ◽

Long Term Follow Up ◽

Free Fibula

Abstract Background The reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success. Case presentation Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout. Conclusions Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication.

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Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up

10.21203/rs.3.rs-105962/v1 ◽

2020 ◽

Author(s):

Tamas Sass ◽

Jozsef Piffko ◽

Gabor Braunitzer ◽

Ferenc Oberna

Keyword(s):

Clinical Status ◽

Case Series ◽

Vertical Dimension ◽

Free Fibula Flap ◽

Large Defect ◽

Fibula Flap ◽

Long Term Follow Up ◽

Free Fibula

Abstract Background: The reconstructive and rehabilitative management of large mandibular defects is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success. Case presentation: Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout. Conclusions: Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in large vertical mandible defects.

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