scholarly journals Salvage Secondary Reconstruction of the Mandible with Vascularized Fibula Flap

2019 ◽  
Vol 12 (4) ◽  
pp. 274-283
Author(s):  
Dinesh Kadam
Keyword(s):  
Soft Tissue ◽  
Tissue Loss ◽  
Successful Outcome ◽  
Primary Reconstruction ◽  
Reconstruction Plate ◽  
Secondary Reconstruction ◽  
Fibula Flap ◽  
Skeletal Defects ◽  
Vascularized Fibula ◽  
Free Fibula

Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This retrospective study evaluates various issues to address secondary reconstruction. Twenty-one patients following mandibulectomy presented with various complications between 2012 and 2016 were included in the study. The profile of primary reconstruction includes reconstruction plate ( n = 9), reconstruction plate with rib graft ( n = 3), soft tissue only reconstruction ( n = 4), free fibula ( n = 2), inadequate growth of reconstructed free fibula during adolescence ( n = 1), nonvascular bone graft alone ( n = 1), and no reconstruction ( n = 1). All had problems or complications related to unsatisfactory primary reconstruction such as plate fracture, recurrent infection, plate exposure, deformity, malocclusion, and failed fibula reconstruction. All were reconstructed with osteocutaneous free fibula flap with repair of soft-tissue loss. All flaps survived and had satisfactory outcome functionally and aesthetically. Dental rehabilitation was done in four patients. One flap was reexplored for thrombosis and salvaged. The challenges in secondary reconstruction include difficulty in recreating true defects, extensive fibrosis and loss of planes, unanticipated soft-tissue and skeletal defects, reestablishing the contour and occlusion, insufficient bone strength, dearth of suitable recipient vessels, nonpliable skin, tissue contraction to accommodate new mandible, need of additional flap for defect closure, and postirradiation effects. Notwithstanding them, the reasonable successful outcome can be attainable.

scholarly journals Reconstruction of post-traumatic long bone defect with vascularised free fibula: A series of 28 cases

2013 ◽  
Vol 46 (03) ◽  
pp. 543-548 ◽  
Author(s):  
Gurdayal Singh Kalra ◽  
Pradeep Goel ◽  
Pradeep Kumar Singh
Keyword(s):  
Soft Tissue ◽  
Bone Defect ◽  
Bone Defects ◽  
High Energy ◽  
Long Bone ◽  
Non Union ◽  
Skeletal Defects ◽  
Free Fibula ◽  
Post Traumatic ◽  
Long Bone Defect

ABSTRACT Introduction: The severe long bone defects usually follow high-energy trauma and are often associated with a significant soft-tissue injury. The goal of management of these open long bone defects is to provide stable fixation with maintenance of limb length and soft-tissue coverage. The purpose of this article is to present the clinic-radiological outcome, complications and treatment of post-traumatic long bone defect with vascularised fibula transfer. Materials and Methods: Retrospective records of 28 patients were analysed who presented with post-traumatic long bone defects and in whom reconstruction with vascularised free fibula was done. Demographic data were recorded and clinical and radiological assessment was done. Results: Out of 28 patients in whom vascularised free fibula transfer was carried out three flaps were lost while non-union occur in three patients. Three patients developed a stress fracture of transferred free fibula in the post-operative period. Few of the patients experienced some problems in the donor leg; however, all of them improved in subsequent follow-up. Discussion: It is clearly evident from this study that timing of surgery plays an important role in the micro-vascular reconstruction in trauma cases. All the complication like flap loss, non-union or delayed union occur in patients in whom reconstruction was delayed. Conclusion: The free vascularised fibula graft is a viable method for the reconstruction of skeletal defects of more than 6 cm, especially in cases of scarred and avascular recipient sites or in patients with combined bone and soft-tissue defects. Results are best when the reconstruction is done within 1 week of trauma.

scholarly journals Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

2021 ◽  
Vol 6 (6) ◽  
pp. 179-187
Author(s):  
Antonio Loro ◽  
Andrew Hodges ◽  
George William Galiwango ◽  
Francesca Loro
Keyword(s):  
Soft Tissue ◽  
Bone Defects ◽  
Sub Saharan Africa ◽  
Soft Tissue Envelope ◽  
Low Resource ◽  
Fibula Flap ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Vascularized Fibula ◽  
Segmental Bone

Abstract. Background: Hematogenous osteomyelitis is commonly observed in the pediatric population across sub-Saharan Africa. This retrospective case series was designed to evaluate the complications and outcomes of treatment using a vascularized fibula flap (VFF) to fill segmental bone defects secondary to osteomyelitis in children in a low-resource setting in CoRSU Rehabilitation Hospital, Uganda. Methods: Clinical notes and radiographs of children with a diagnosis of osteomyelitis that subsequently underwent a VFF procedure between October 2013 and December 2017 were reviewed. All patients were clinically and radiographically evaluated in 2019. Results: Forty-four children, with an average bone defect of 10.5 cm, were included. Eighty-four percent of children had successful VFF limb reconstruction. Integration of the graft was radiologically sound in 20.8 weeks on average. The postoperative phase was uneventful in 29 % of patients. Complications were observed in the remaining patients, including flap failure (6), donor leg neurapraxia (3), cutaneous paddle necrosis (11), graft fracture (2), skin graft loss (6), fixator failure (1) and non-union (2). Functional outcomes were rated as excellent in 13 patients, good in 14, fair in 9 and poor in 8. There was no recurrence of the bone infection in any of the enrolled children. Conclusion: Despite being a complex and demanding procedure, VFF is a good option for reconstructing post-osteomyelitis bone defects, particularly when associated with loss of soft tissue envelope. Considering the more than satisfactory functional and clinical outcomes, this procedure should be kept in mind for these complex pediatric cases of bone and soft tissue loss, even in a low-resource setting.

scholarly journals Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

2020 ◽  
Author(s):  
Lucas M. Ritschl ◽  
Thomas Mücke ◽  
Diandra Hart ◽  
Tobias Unterhuber ◽  
Victoria Kehl ◽  
...  
Keyword(s):  
Radiation Dosage ◽  
Iliac Crest ◽  
Treatment Algorithm ◽  
Mandibular Reconstruction ◽  
Total Radiation ◽  
Contributing Factors ◽  
Reconstruction Plate ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Free Fibula

Abstract Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

scholarly journals Thirty-eight-year Follow-up of the First Patient of Mandibular Reconstruction with Free Vascularized Fibula Flap

2021 ◽  
Author(s):  
Edela Puricelli ◽  
Roberto Correa Chem
Keyword(s):  
Soft Tissues ◽  
Mandibular Reconstruction ◽  
Facial Morphology ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Vital Functions ◽  
First Case ◽  
Vascularized Fibula ◽  
Free Fibula

Abstract Background: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction.Case presentation: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

scholarly journals Orbital Floor Reconstruction with Free Flaps after Maxillectomy

2013 ◽  
Vol 6 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Leela Mohan C. S. R. Sampathirao ◽  
Krishnakumar Thankappan ◽  
Sriprakash Duraisamy ◽  
Naveen Hedne ◽  
Mohit Sharma ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Soft Tissue ◽  
Free Flaps ◽  
Orbital Floor ◽  
Soft Tissue Reconstruction ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Orbital Floor Reconstruction ◽  
Free Fibula ◽  
Tissue Reconstruction

Background The purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy. Methods This was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. A cross-sectional survey to assess the functional and esthetic outcome was done in 28 patients who were alive and disease-free, with a minimum of 6 months of follow-up. Results Twenty-six patients had bony reconstruction, and eight had soft tissue reconstruction. Free fibula flap was the commonest flap used ( n = 14). Visual acuity was normal in 86%. Eye movements were normal in 92%. Abnormal globe position resulted in nine patients. Esthetic satisfaction was good in 19 patients (68%). Though there was no statistically significant difference in outcome of visual acuity, eye movement, and patient esthetic satisfaction between patients with bony and soft tissue reconstruction, more patients without bony reconstruction had abnormal globe position ( p = 0.040). Conclusion Free tissue transfer has improved the results of orbital floor reconstruction after total maxillectomy, preserving the eye. Good functional and esthetic outcome was achieved. Though our study favors a bony orbital reconstruction, a larger study with adequate power and equal distribution of patients among the groups would be needed to determine this. Free fibula flap remains the commonest choice when a bony reconstruction is contemplated.

The Free Fibula Flap

2019 ◽  
pp. 431-448
Author(s):  
Matthew T. Houdek ◽  
Steven L. Moran
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Long Bone ◽  
Bony Union ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Vascularized Fibula ◽  
Microvascular Flap ◽  
Free Fibula ◽  
Tumor Extirpation

The free vascularized fibula flap has become the most common microvascular flap option for long bone and mandibular reconstruction following trauma and tumor extirpation. The free fibula flap can provide up to 26 cm of straight, cortical bone and has acceptable donor site morbidity. Published series have noted high rates of reconstructive success, with primary bony union rates of up to 80% and overall union of 97% following supplemental nonvascularized bone grafting. It is a true workhorse flap and one that all reconstructive plastic surgeons need to be familiar.

scholarly journals Thirty-eight-year follow-up of the first patient of mandibular reconstruction with free vascularized fibula flap

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Edela Puricelli ◽  
Roberto Correa Chem
Keyword(s):  
Soft Tissues ◽  
Mandibular Reconstruction ◽  
Facial Morphology ◽  
Free Fibula Flap ◽  
Fibula Flap ◽  
Vital Functions ◽  
First Case ◽  
Vascularized Fibula ◽  
Free Fibula

Abstract Background The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction. Case presentation We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

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
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