The fibula free flap fff has been a workhorse in maxillofacial reconstruction. Request pdf fibula free flap the fibula is a bone located in the lateral portion of the leg measuring approximately 40 cm. The leg is the donor site that is most often used for jaw reconstructions. Direct comparisons of nvbgs and vascularized bone flaps. Fibula flap harvest the patient is placed in the supine position with a bump under the ipsilateral hip to lessen the need for excessive internal rotation of the lower leg. Fibula osteocutaneous free flap dissection surgical video. This extension of flap raising became possible following the proposal of gilbert to use a lateral approach for harvesting the bone flap, which was easier to perform and allowed for visualization of the cutaneous. Your jaw may be rebuilt using bone from another part of your body the donor site. As with any free flap, complications may be divided into donor and recipient site problems.
Objective to present our experience with fibulafree tissue transfer in patients with documented 2vessel runoff to the lower extremity on preoperative angiography. If you have any other questions that the leaflet does not answer or would like further explanation please ask. The doublebarrel fibula technique was introduced by jones et al. Free fibular flap transfer for mandibular defects in head and neck cancer patients is widely performed. Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. A fibular free flap is one way to fill a hole in either the upper or lower jaw. Microvascular free tissue transfer allows one to transfer. If your jaw is being rebuilt using bone from a different donor site or.
Osteocutaneous fibula free flap carver college of medicine the. Duplex scanning prior to fibula free flap transfers. 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. The microvascular free fibula flap has become the gold standard for reconstruction of complex mandibular defects since its description by hidalgo in 1989. The fibula free flap seems to be the best free flap to apply in this type of reconstruction, partial maxillectomy, in particular, can benefit from reconstruction with the double barrelled fibula free flap. It is articulated superiorly with the lateral tibial.
It is one of the common ways of replacing bone that has been removed for cancer treatment. The free fibula osteocutaneous flap has become the workhorse flap for reconstruction of complex defects requiring vascularized bone. Mandible reconstruction is routinely performed in highvolume academic centers. This can be considered a safe surgical procedure even in elderly head and neck cancer patients 1. The fibula free flap can undergo various modifications according to the individual requirements of a. The role of cta in the preoperative workup of free fibular. The layered fibula osteocutaneous flap sets new standard.
Fibula free flap in mandibular reconstruction atlas of the oral. The advent of microvascular surgery has catapulted the reconstruction of complex head and neck defects to a single stage reconstruction. The three fibula sections are shown at the top of figure 7. Study of mandible reconstruction using a fibula flap with. As with any surgery, hematoma or infection may develop. According to us, fibula freeflap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. The utility of ct angiography in diagnosing vascular variations and disease is welldocumented. During reconstruction by free fibula flap, skin and a portion of fibula in the adjoining soft tissue are harvested when the fibula is removed, and the fibula and soft tissues are used to restore the defect by microscopic anastomosis surgery to allow integration with the arteries and veins of the neck 1. Donor site morbidity is low and its location facilitates the 2 team. To learn more about the department of otorhinolaryngology at mayo clinic, visit.
Fibula osteocutaneous free flap harvest american head. Free vascularised fibular flap harvesting in children. The fibular bone runs on the outside of the leg from the knee joint to the ankle joint. Reconstruction of the sternumdefect, regardless of the reason, should ensure the stability of the anterior chest wall, the return of acceptable respiratory parameters and the control of wounds.
Angioct preoperative planning of inferior limb free flaps. Fibula free flap in mandibular reconstruction request pdf. It can be raised with a skin island for compositetissue reconstruction. The neurocutaneous free fibula flap in mandible reconstruction. Ct angiography may be used preoperatively to evaluate the vascular supply of the lower leg prior to free fibula flap harvest. Here, we aimed to establish the preplating technique for oromandibular reconstruction in a stepbystep fashion, based on 41 patients.
Peng, reconstruction of maxillary defects with free fibula flap assisted by computer techniques, journal of. Zaccardi neal futran microvascular free tissue transfer is commonly used for reconstruction of complex head and neck defects. It is often used to replace bone that has been removed for cancer treatment. Duplex scanning prior to fibula free flap transfers molly j. The fibula from the same side of the body as the tumor is selected for harvesting. Loss of the skin graft or a portion thereof is possible.
Its advantages include the fibula bone being long, straight and strong, and since first described in the role by hidalgo, it has become the workhorse of free tissue. Stability of the chest wall can be provided by autogenous tissues or prosthetic materials. Review of 60 consecutive fibula free flap mandible reconstruction. Advancing education, research, and quality of care for the head and neck oncology patient. About your mandibulectomy and fibula free flap reconstruction. The pedicle runs the length of the fibula, with perforators extending to supply the skin paddle. The single fibular flap origami technique obviates. It is a small thin bone that can be entirely removed without affecting your ability to bear weight. Surgery went well, except that his arteries were severely damaged from radiation, and the surgeons had difficulty getting good blood flow to the flap.
Fibula osteoseptocutaneous free flap in maxillary reconstruction. It has the advantages of consistent shape, ample length, distant location to allow a twoteam approach, and low donorsite morbidity. After shaping the fibula sections, the mandibular repair can be constructed using those sections, as shown in. The fibula was investigated as a donor site for freeflap mandible reconstruction. To our best knowledge, this is the first case series exclusively dedicated on. This handout gives self care instructions to follow at home after yo ur surgery. A fibular free flap is one way of filling a bony hole in either the upper or. The development of free bone flaps for use in maxil. Mandibular reconstruction using fibula free flap harvested. Otolaryngology head and neck surgery center after your. Analysis of the compatibility of dental implant systems in. Free fibula flap is routinely used for large jaw reconstructions 4 5.
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. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap. A prospective study of preoperative computed tomographic. The fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. The use of fibula free flap for reconstruction of anterior chest wall fullthickness defects open access ojts 110 cially after postoperative radiotherapy or resection that is performed due to infections 1. So, back into surgery he went five days later using the. A004 wwu solid freeform fabrication assisting free fibula. Osteocutaneous fibula free flap iowa head and neck protocols. Whereas these first transfers of the fibula have been performed without including a skin paddle, chen and yan were the first to report about an osteocutaneous fibula flap in 1983. It has been cited, however, for having limited application for total maxillectomy defects, including those in the orbital floor, the alveolar arch and more than half of the palate. The fibula free flap has been advocated for reconstruction of lower palatal and alveolar defects with the advantage of allowing for osseointegrated dental implants.
With a wide variety of etiologies of chest wall defects and varying degrees of complexity, the decisionmaking in reconstruction can be. Preoperative color flow doppler imaging for fibula free tissue transfers. Composite free fibula flap for complex defects of the mandible. The purpose of this study was to describe the computerassisted mandibular reconstruction procedure adopting the customized solution synthes proplan cmf. Mandible reconstruction with free fibula flap plastic. An artery, vein, and soft tissue will also be removed with the bone. Drains are used in the leg until output is sufficiently low for removal. The free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios. Transfer of a free vascularised fibular flap fvff is an option for treating bone defects of 5 cm or more in children. In paediatric patients, the fvff is used chiefly for bone defects due to a tumour, infection, or trauma, although other indications include congenital pseudarthrosis of the tibia and avascular. The study reports five consecutive patients with benign or malignant disease requiring. Fibula definition of fibula by the free dictionary.
Please be advised that this video contains graphic footage of surgery. Fibula osteocutaneous free flap dissection video youtube. It can be harvested as a purely osseus flap or can include a large fasciocutaneous component if needed. 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. As such this versatile flap may be harvested as an osteocutaneous flap or a purely osseous flap. Download as an information leaflet pdf fibular free flap.
However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. Osseointegrated dental fibula free flaps for mandibular. According to us, fibula free flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. The purpose of this study was to evaluate the safety and efficacy of performing a second free fibula flap reconstruction after repeated segmental mandibulectomy. Exploratory benchtop study evaluating the use of surgical. The fvff technique was first developed by taylor et al. Utility of digital surgical simulation planning and solid free form modeling in fibula free flap mandibular reconstruction. Reconstructions of the sternum remain a formidable challenge for the operating team. The fibula free flap provides a strong long segment of bone and can include a large fasciocutaneous component as well.
Patients will be in the icu for 24 days and are usually sedated asleep for 2448 hours. They lost blood flow two days later and tried to salvage the flap. Major donor site complications with a fibula free flap are uncommon. 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.
Advantages and limitations of the fibula free flap in mandibular. At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. Uwmc otolaryngology head and neck surgery center box 356161 1959 n. It is now the most popular method of mandibular reconstruction. The fibular flap is widely accepted as the mainstay of.
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. Page 3 of 5 your hospital stay after fibular free flap surgery. The fibula free flap fff constitutes the gold standard surgical approach for mandibular reconstruction. The use of fibula free flap for reconstruction of anterior. Reconstruction of partial maxillary defects with the doublebarrel fibula free flap. The fibula free flap has sufficient bone stock to span large segmental mandibulectomy defects and support osseointegrated implants.
The osteocutaneous free fibula flap offf was initially described by taylor in 1975 and it has been used as a frontline reconstructive tool for trauma and cancer since 1983. A fibular free flap is one way of filling a bony hole in either the upper or lower jaw. 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. Evaluation of foot perfusion after fibula flap surgery. Free flaps, combining a high success rate with low donor site morbidity, are considered the gold standard for the reconstruction of tissues lost during oncologic surgery. 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. Use of fibulafree tissue transfer with preoperative 2. The fibula free flap provides a long, strong segment of bone for use in reconstructive surgery.
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