Its use in mandibular reconstruction was first described in 1989, by hidalgo, with fibular reconstruction now being the criterion standard for the reconstruction of mandibular and. As such this versatile flap may be harvested as an osteocutaneous flap or a purely osseous flap. A mandibular defect and corresponding free fibula flap reconstruction requiring six osteotomies were designed on a cad platform. Fibula osteocutaneous free flap dissection video youtube. Vascularised free fibula flap fff technique in head and neck. Indications the fibula flap has been used extensively for oromandibular reconstruction. Microvascular reconstruction of the mouth, face and jaws. Quizlet flashcards, activities and games help you improve your grades. The overall study cohort comprised of 61 consecutive patients, with 20 patients reconstructed with the free fibula flap and 41 patients with softtissue flaps and bridging plates in. Stepbystep mandibular reconstruction with free fibula flap modelling. The fibula osteocutaneous flap in head and neck reconstruction. Sep 19, 2018 the fibula free flap was introduced in the mid1970s for the reconstruction of tibial defects.
The fibula free flap is the firstchoice flap for reconstruction of bony defects in the mandibula at our institution. The skin segment of the fibula flap is quite reliable and thin and is used to close the skin defect. Fibula osteocutaneous flap for mandible reconstructionafter. The role of cta in the preoperative workup of free fibular. Jun 26, 2016 the free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a. The fibula is a small, thin bone that runs along the outer part of the lower leg from the knee to the ankle. We present two cases of infected nonunion of both the ulna and radius treated with a doublebarrel free fibula flap. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap. The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings.
Over the past two decades, microvascular free tissue transfer has become a common procedure, usually with predictable results. Iowa head and neck protocols osteocutaneous fibula free flap. In many developing countries, however, these services are not available. Venous failure still represents the most common complication in free flap surgery. Anterior mandibular reconstruction prep and drape osteocutaneous fibula free flap general considerations. Pdf free fibula flap is routinely used for mandibular reconstructions. Evaluation of fibula free flap donor site morbidity. The fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. The most dreaded major donorsite complication of free fibula flap is a foot ischemia, which is fortunately rare. The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. Shows a posterior approach ao foundation fibula osteocutaneous flap the fibula flap. Microvascular free tissue transfer allows one to transfer wellvascularised, bone containing flaps for oromandibular and midface reconstruction. Here, we aimed to establish the preplating technique.
The bone flap was left in place with its pedicle intact for 2 to 3 months, after which the skin graft had taken and the flap was free of inflammation. The resulting 8cm bone and 4 x 10cm mucosa defects were reconstructed with the prepared free osteocutaneous fibula flap figure 2c. Fibula free flap is now the attitude of choice for most authors,,, but other flaps iliac crest, scapula still have a role to play in selected cases. You may have a mandibulectomy if you have a tumor involving your jaw. Fibula free flap in mandibular reconstruction atlas of the oral. If your jaw is being rebuilt using bone from a different donor site or if bone will not be used in your reconstruction, your plastic surgeon will discuss this with you. Donor side selection in mandibular reconstruction using a free fibular osteocutaneous flap. Free fibula reconstruction of distal tibial defects after.
The free fibula flap provides the greatest bone length, is suitable to accept dental implants and allows incorporation of a skin island for mouth floor or lip reconstruction. Fibula free flap is known to be a safe and reliable method to get a sufficient height and appropriate thickness of corresponding mandible 5,6. The single fibular flap origami technique obviates a 2flap harvest. According to us, fibula free flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. Free fibula flap study guide by drchelly includes 8 questions covering vocabulary, terms and more.
Research open access analysis of the compatibility of dental implant systems in fibula free flap reconstruction ramin carbiner1,2, waseem jerjes3,4,5, kaveh shakib6, peter v giannoudis4,5 and colin hopper1,2,3 abstract as a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the. Fibula free flap is a feasible option for reconstruction of large osseous defects in the mandible. Mandibulectomy and free flap reconstruction a mandibulectomy is a surgery to remove all or part of your jaw mandible. Stepbystep mandibular reconstruction with free fibula. Mandibular reconstruction with a microvascular free fibula flap mff is an elegant solution to restore the anatomic arch, oral functions, and facial esthetics. Pdf mandibular reconstruction using fibula free flap harvested. The bone may be taken from your fibula, which is the smaller of. Fibula osteocutaneous free flap harvest american head. The fibula free flap fff has been a workhorse in maxillofacial reconstruction. There is no donor side specificity of fibula free flap for complex oromandibular reconstruction. Indications the fibula flap has been used extensively for. Even though each step in modelling the flap is important, fibula preplating and templating should be considered to be crucial steps for facilitating the procedure and guaranteeing a satisfactory result.
Various authors have discussed the efficacy of the use of preoperative imaging methods including color doppler, magnetic resonance angiography, and conventional angiography. Because of the complexity of these composite defects, free fibula osteocutaneous flap is regarded as a good choice for reconstruction 3. A high incidence of oscc is seen in pakistani population, with the most affected patients being in 4th 6th decades of their life 4. The overall study cohort comprised of 61 consecutive patients, with 20 patients reconstructed with the free fibula flap and 41 patients with softtissue flaps and. The fibula osteocutaneous free flap is effective for managing most mandibular defects. Since then the fibula free flap has enjoyed much popularity for mandibular reconstruction and has continued to undergo technical developments. The fibula free flap has sufficient bone stock to span large segmental mandibulectomy defects and support osseointegrated implants. It was introduced to reconstructive surgical practice by taylor et al.
To learn more about the department of otorhinolaryngology at mayo clinic, visit. At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Surgery went well, except that his arteries were severely damaged from radiation, and the surgeons had difficulty getting good blood flow to the flap. Your jaw may be rebuilt using bone from another part of your body the donor site. The flexibility of the fibula in threedimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. Pdf free fibula flap for humerus segmental reconstruction. Fibula free flap and mandibular reconstruction pocket. Patients will be in the icu for 24 days and are usually sedated asleep for 2448 hours. This document contains information andor instructional materials developed by the university of michigan health system umhs for the typical patient with your condition. Fibula osteocutaneous free flap dissection surgical video. In terms of recipient site complication, there was a significantly higher risk of delayed healing and suture line breakdown in the iliac flap group p 0. Hidalgo in 1989 performed the first mandibular reconstruction with a segment of fibula by using multiple defined osteotomies to reproduce the shape of almost an entire mandible.
Fibula article about fibula by the free dictionary. If less skin paddle is needed, a smaller paddle can be drawn, or the skin can be trimmed after the flap is harvested. Fibular free flap how is fibular free flap abbreviated. Mandible reconstruction with free fibula flap john bradley turner henry c. In conclusion, mandibular reconstruction using a free fibula flap can achieve good functional and cosmetic outcomes. Maxillary reconstruction with the free fibula flap. The fibula free flap provides a strong long segment of bone and can include a large fasciocutaneous component as well. The axis of the skin paddle is drawn at the posterior border of the fibula. About your mandibulectomy and fibula free flap reconstruction. In this paper, we audit free flaps done in a resource constrained hospital in kenya. Mandible reconstruction with free fibula flap plastic.
The fibula free flap was introduced in the mid1970s for the reconstruction of tibial defects. Fibular free flap this leaflet has been designed to improve your understanding of any forthcoming treatment and contains answers to many of the commonly asked questions. Duplex scanning prior to fibula free flap transfers. Please be advised that this video contains graphic footage of surgery. Vascularized free fibular flap for mandibular reconstruction joms. Donor site morbidity is low and its location facilitates the 2 team. Callous formation was documented after an average time of 4 months, partial weight bearing after an average time of 4 months, and full weight bearing after an average time of 11. It is now the most popular method of mandibular reconstruction. Free vascularized fibula flap alpha hand surgery centre.
May 05, 2016 fibula osteocutaneous free flap dissection surgical video. Fibula free flap the leg is the donor site that is most often used for jaw reconstructions. In the setting of fibular free flap transfer procedures, the peroneal artery is routinely resected along with the fibular flap so that once anastamosed. Aug 09, 2012 in conclusion, mandibular reconstruction using a free fibula flap can achieve good functional and cosmetic outcomes. All patients regained almost normal ambulation within a year. The fibula flap serves as the workhorse for many mandibular defect types. Prosthetic challenges in a free fibula flap mandibular. The paddle is outlined a few centimeters below the neck of the fibula and 5 to 5 centimeters above the medial malleolus.
However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. Vasconez editorial comment the way to go in bony mandibular reconstruction. Fibula free flap in mandibular reconstruction request pdf. It has been demonstrated that for defects greater than 6 cm, the flap has a significantly higher rate of success than nonvascularized bone grafts, especially in hostile environments. Mandibulectomy and freeflap reconstruction a mandibulectomy is a surgery to remove all or part of your jaw mandible. The terms free flap, free autologous tissue transfer and microvascular free tissue transfer are synonymous terms used to describe the transplantation of tissue from one site of the body to another, in order to reconstruct an existing defect. Fibula free flap phalloplasty ftm phalloplasty surgery. Osteocutaneous fibula free flap iowa head and neck protocols. We evaluated 46 patients who underwent fibula free flap reconstruction for segmental mandibulectomy defects and either simultaneous or delayed osseointegrated dental implantation to the vascularized fibula. The osteomyocutaneous free fibula flap in mandibular. The purposes of this study were to 1 compare the complications and functional outcome of primary closure vs splitthickness skin grafting of the fibula osteocutaneous flap donor site, 2 identify patientmix and treatment factors that may be related to the development of donor site complications, and 3 address early detection and.
A methodology was developed to translate this virtual surgical plan data to a robot kuka, augsburgs, germany, which then executed osteotomies on three. This is a fiveyear audit of free flaps done in a tertiary hospital in kenya, between 2009 and 2014. The results of 26 vascularized free fibula flaps with or without a skin paddle that were used. The fibula osteocutaneous free flap is harvested in the standard fashion with the following considerations. An artery, vein, and soft tissue will also be removed with the bone. Free flap surgery is a routine procedure in many developed countries with good surgical outcomes. Fibula definition of fibula by the free dictionary. Hidalgo published the first case series in which a fibula free fl ap was used for mandibular reconstruction. It is one of the common ways of replacing bone that has been removed for cancer treatment. Download as an information leaflet pdf fibular free flap. The fibula was investigated as a donor site for freeflap mandible reconstruction. It can be raised with a skin island for compositetissue reconstruction. Stepbystep mandibular reconstruction with free fibula flap.
Composite free fibula flap for complex defects of the. The main postoperative functional indices, including oral diet, speech, type of dental restoration, and aesthetic results, were evaluated. Donor site morbidity of the fibula free flap has been evaluated in a large series of orthopedic patients. Indications the free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios 1. Osseointegrated dental fibula free flaps for mandibular. Fibulafree flap is a feasible option for reconstruction of large osseous defects in the mandible. It may include links to online content that was not created by umhs and for. Many options exist for transfer of free vascularized bone, but the fibula free flap is the most widely used for reconstruction of ablative, posttraumatic, or congenital mandibular.
Free implies that the tissue is completely detached from its blood supply at the original location. Anatomic basis for an algorithmic approach for free fibula flap donor side selection in composite oromandibular defects. The study reports five consecutive patients with benign or malignant disease requiring. Mandibular reconstruction using the free vascularized fibula graft. Debate over several technical aspects of the flap dissection continues to take place in the literature, specifically with regard to skin island viability and donor leg morbidity. Its use in mandibular reconstruction was first described in 1989, by hidalgo, with fibular reconstruction now being the criterion standard for the reconstruction of mandibular and maxillary bony defects. Free fibula flap postoperative instructions 3 disclaimer.
The reliability of the skin paddle harvested with the fibula flap has been questioned. They lost blood flow two days later and tried to salvage the flap. We presented our experiences and knowledge from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at national cancer center during the recent. Fuchan wei showed the reliability of the skin island in 1986. The advent of microvascular surgery has catapulted the reconstruction of complex head and neck defects to a single stage reconstruction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap fff. For contouring the flap, multiple osteotomies should be shaped to.
Duplex scanning prior to fibula free flap transfers molly j. Mandibular reconstruction with the fibula osteocutaneous. Ian taylor, an australian surgeon first described the fibula as a free fl ap in 1975, and dr. While acetabular and femur fractures, as well as posterior hip dislocations may compromise the. A fibular free flap is surgery that removes the fibula and uses it to reconstruct bone in the upper or lower jaw that has been damaged or removed due to cancer. Free implies that the tissue is completely detached from its blood supply at the original location donor site and then transferred to another. Zaccardi neal futran microvascular free tissue transfer is commonly used for reconstruction of complex head and neck defects. Free fibula flap for humerus segmental reconstruction. The fibula free flap can undergo various modifications according to the individual. Of the 34 patients who underwent maxillary reconstruction with the free fibula flap, the primary diseases were malignant. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies.
Jul 24, 2012 the free fibula flap fff is a free tissue transfer of the fibula overlying skin with its vascular pedicle to a recipient site. Free fibula flap fff phalloplasty is a good alternative to the radial forearm phalloplasty for patients who do not want a forearm scar. Free flap outcomes of microvascular reconstruction after. It has the advantages of consistent shape, ample length, distant location to allow a twoteam approach, and low donorsite morbidity. The purpose of this study was to describe the computerassisted mandibular reconstruction procedure adopting the customized solution synthes proplan cmf. The results of this metaanalysis confirm that there is no significant difference in total flap loss between fibula and iliacfree flap reconstruction of mandibular defects. Use of the doublebarrel free fibula flap can restore ulna and radius continuity to maximally preserve pronationsupination and longterm function. The short pedicle can be made longer by dissecting it free of the proximal fibula, and using the distal bone for the reconstruction. Analysis of the compatibility of dental implant systems in. If you have any other questions that the leaflet does not answer or would like further explanation please ask.
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