Esthetic and Functional Reconstruction of the Posttumoral Interrupted Mandible With Double-Barrel Fibular Free Flap Graft: Rationale for a Microsurgical and Prosthodontic Approach

2011 ◽  
Vol 37 (5) ◽  
pp. 571-577 ◽  
Author(s):  
Armand-Régis Paranque ◽  
Marc Steve ◽  
Lydia Vazquez ◽  
Alain Bolleyn ◽  
Marie-Andrée Roze-Pellat ◽  
...  
Keyword(s):  
Free Flap ◽  
Tissue Loss ◽  
Fibular Graft ◽  
Muscular Tissue ◽  
Fixed Partial Denture ◽  
Immediate Implant ◽  
Mandibular Defect ◽  
Fibular Free Flap ◽  
Permanent Implant ◽  
Implant Loading

Reconstruction after substantial osseous, cutaneous, and muscular tissue loss following a mandibular resection is a challenge. The use of a fibular free flap is an outstanding, but delicate, treatment option. These grafts, using the double-barrel technique, can achieve an almost complete reconstruction of the mandibular defect. The challenge posed by these treatments is to achieve an end result that is both functional and esthetically pleasing—an endeavor that requires a defined prosthetic plan prior to complete microsurgical reconstruction. Using a detailed clinical case, this article discusses the importance of planning the mandible reconstruction with double-barrel fibular graft in view of an implant-supported fixed partial denture. Immediate implant loading was even possible in this case. This approach allows improvement of the final esthetic and functional result of such a complex rehabilitation. Maxillofacial reconstructive surgery should seek to establish a near-as-normal anatomic situation that will allow a permanent implant rehabilitation that is both esthetic and durable.

Fibular Free Flap Reconstruction of the “True” Lateral Mandibular Defect

1997 ◽  
Vol 38 (2) ◽  
pp. 137-146 ◽  
Author(s):  
James P. Anthony ◽  
Robert D. Foster ◽  
Michael J. Kaplan ◽  
Mark I. Singer ◽  
M. Anthony Pogrel
Keyword(s):  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Mandibular Defect ◽  
Fibular Free Flap

Osteotomising the fibular free flap: an anatomical perspective

2016 ◽  
Vol 54 (6) ◽  
pp. 692-693 ◽  
Author(s):  
A.M. Fry ◽  
Dave Laugharne ◽  
Keith Jones
Keyword(s):  
Free Flap ◽  
Fibular Free Flap

P.316 Fibular free flap for almost total maxillary reconstruction

2006 ◽  
Vol 34 ◽  
pp. 212
Author(s):  
F.J. Alamillos ◽  
A. Dean ◽  
A. Redondo ◽  
J.J. Ruiz
Keyword(s):  
Free Flap ◽  
Fibular Free Flap

scholarly journals Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Catherine Kilmartin ◽  
Katharine D. Harper ◽  
Chirag Mehta ◽  
Joseph Thoder ◽  
Andrew Newman
Keyword(s):  
Limb Salvage ◽  
Free Flap ◽  
Radial Head ◽  
Radial Head Prosthesis ◽  
Review Of The Literature ◽  
Joint Function ◽  
Radial Head Arthroplasty ◽  
Elbow Function ◽  
Fibular Free Flap ◽  
Proximal Forearm

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius. The patient has sustained a 5.5 cm epiphyseal radial defect with an associated 20 × 15 cm overlying tissue defect after serial debridement. In review of the literature, only one nontraumatic case using a combined free flap and radial head prosthesis for proximal forearm defect to restore joint function has been reported. We suggest that, for proximal forearm fractures, this technique can be used to restore elbow joint function in limb salvage.

Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome

2018 ◽  
Vol 35 (02) ◽  
pp. 156-162 ◽  
Author(s):  
Magdy Sherbiny ◽  
Nehal Kamal ◽  
Ahmed Ghoneimy
Keyword(s):  
Functional Outcome ◽  
Free Flap ◽  
Average Length ◽  
Femoral Shaft ◽  
Wide Resection ◽  
Level Of Evidence ◽  
Bone Sarcomas ◽  
Fibular Free Flap ◽  
The Mean ◽  
Resected Femoral

Background Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. Methods Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. Results The mean follow-up period was 48.7 months (12–104 months). The mean age at presentation was 10.3 years (5–17 years). The average length of the resected femoral shaft was 19.2 cm (15–24 cm) and the average length of the harvested fibula was 17.4 cm (15–21 cm). The mean time to union was 4.8 months (1–6 months) and the mean hypertrophy index was 78% (15.5–184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56–100%) and the mean limb length inequality was 4.75 cm (3–11 cm). Conclusion Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. Level of Evidence IV.

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

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