Osseointegrated dental implants in fibular free flaps can be used to reconstruct segmental. Evaluation of foot perfusion after fibula flap surgery. Nov 25, 2016 osteoradionecrosis is the most dreadful complication after head and neck irradiation. About your mandibulectomy and fibula free flap reconstruction. As such this versatile flap may be harvested as an osteocutaneous flap or a purely osseous flap. Fibula definition of fibula by the free dictionary.
A new procedure assisted by digital techniques for. It is a small thin bone that can be entirely removed without affecting your ability to bear weight. The free fibula flap has of late become the most popular free flap for mandible reconstruction and is now considered the gold standard. Pdf fibula free flap splitting for mandible reconstruction. Free flaps, combining a high success rate with low donor site morbidity, are. 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. The layered fibula osteocutaneous flap sets new standard for. It is now the most popular method of mandibular reconstruction. This can be considered a safe surgical procedure even in elderly head and neck cancer patients 1. Download as an information leaflet pdf fibular free flap. Since then the fibula free flap has enjoyed much popularity for mandibular reconstruction and has continued to undergo technical developments. The fibula has both medullary and periosteal blood supplies. Analysis of the compatibility of dental implant systems in.
Your jaw may be rebuilt using bone from another part of your body the donor site. 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. 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. Mandible reconstruction is routinely performed in highvolume academic centers. This study was to investigate the success rate and results of the free fibular flap for. Osteoradionecrosis is the most dreadful complication after head and neck irradiation. The pedicle runs the length of the fibula, with perforators extending to supply the skin paddle.
Skin paddle vascularity of free fibula flap a study of 386 cases and a classification based on contribution from axial vessels of the leg 2012. Orocutaneous fistula makes patients difficult to eat food. 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 orofacial region. An artery, vein, and soft tissue will also be removed with the bone. Reconstruction of partial maxillary defects with the doublebarrel. As with any surgery, hematoma or infection may develop. The purpose of this study was to evaluate the safety and efficacy of performing a second free fibula flap reconstruction after repeated segmental mandibulectomy. At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. Reconstruction of premaxilla with fibula free flap. A prospective cohort study of fibula free flap donorsite morbidity in 157 consecutive patients. However, no previous studies have established the longterm results of such reconstructions.
You will have a breathing tube and will be on a ventilator for 24 48 hours. Fibula free flap the leg is the donor site that is most often used for jaw reconstructions. Five defects consisted of bone alone, and four others had only a small amount of associated intraoral softtissue loss. Twenty patients underwent a second free fibula flap reconstruction after a second mandibulectomy. Oromandibular reconstruction with osteocutaneous fibula free flap and endosseous implants has recently become the method of choice for patients with oral cancer who undergo extensive tumour removal, including mandibular resection and complex softtissue excision. Fibula osteocutaneous flap for mandible reconstructionafter. Osteocutaneous fibula free flap iowa head and neck protocols. Fibular free flap how is fibular free flap abbreviated. Reasons for this resonate with its adequate bone and pedicle length to its receptive dental implant placement quality 4 7. 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. Reconstruction of premaxilla with fibula free flap request pdf. 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.
The study reports five consecutive patients with benign or malignant disease requiring. The utility of ct angiography in diagnosing vascular variations and disease is welldocumented. The fibular bone runs on the outside of the leg from the knee joint to the ankle joint. In comparison with other osteocutaneous flaps, the fibula flap offers many advantages and is associated with.
The fibula is the longest bone flap available and can be transferred as a bone flap or in combination with one or two skin paddles. Major donor site complications with a fibula free flap are uncommon. Using a second free fibula osteocutaneous flap after. Free fibula flap is routinely used for large jaw reconstructions 4 5.
If your jaw is being rebuilt using bone from a different donor site or. Conclusions use of the fibula osteocutaneous free flap to reconstruct the midface is. To learn more about the department of otorhinolaryngology at mayo clinic, visit. This benefits readers because the content is on one page, and future readers because a single edit can affect more content. Surgery went well, except that his arteries were severely damaged from radiation, and the surgeons had difficulty getting good blood flow to the flap. Efficacy of dental implants placed into fibulafree flaps for. If the peroneal artery is disrupted the graft will remain intact if the periosteal system remains intact. It can be harvested as a purely osseus flap or can include a large fasciocutaneous component if needed. Reconstruction was performed for head and neck defects that resulted from tumor resection 47 patients, trauma 3 patients, and osteoradionecrosis 3. Surgical navigationassisted mandibular reconstruction with fibula. May 10, 2014 at present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. Free fibula flap study guide by drchelly includes 8 questions covering vocabulary, terms and more. In a prospective study, 16 consecutive patients who received free fibula grafts and in total 51 dental implants between 1999 and 2001 were examined. Surgical navigationassisted mandibular reconstruction with fibula flaps.
Jun 26, 2016 the free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios. Jul 17, 2018 microsurgery double free flap fibula and alt head and neck reconstruction. Pdf the purpose of this study was to determine the donor leg morbidity and function after removal of the fibula free flap for mandible. Fibula free flap in mandibular reconstruction request pdf. The fibula free flap provides a long, strong segment of bone for use in reconstructive surgery. Manual and global registration functions were used to match the nonsurgical parts of.
Fibular free flap is the choice of the flap for mandibular reconstruction. Request pdf fibula free flap the fibula is a bone located in the lateral portion of the leg measuring approximately 40 cm. To describe a new procedure assisted by digital techniques for secondary mandibular reconstruction with free. Donor site morbidity is low and its location facilitates the 2 team. Mandible reconstruction with free fibula flap john bradley turner henry c. Dec 12, 2017 the fibula free flap fff constitutes the gold standard surgical approach for mandibular reconstruction. Ages ranged from 20 to 80 years, with a mean of 54 years. The leg is the donor site that is most often used for jaw reconstructions. Onestage, doublebarrel fibula osteoseptocutaneous flap and immediate dental implants for functional and aesthetic reconstruction of segmental mandibular defects. This is an open access article distributed under the terms of the creative commons attributionnoncommercialsharealike 3. In this study, a new method combining preoperative planning and rapid. Mandible reconstruction with free fibula flap plastic.
Periimplant softtissue management in patients with a fibula free flap reconstruction. The fibula free flap fff constitutes the gold standard surgical approach for mandibular reconstruction. Importance bisphosphonaterelated osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy. Freeflap reconstruction of oncologic mandibular defects has become the modern standard of care. Preoperative color flow doppler imaging for fibula free tissue transfers. Fibula free flap, mandibular reconstruction, cadcam technique, cutting guide. Efficacy of dental implants placed into fibulafree flaps. Periimplant softtissue management in patients with a fibula free flap. Fiftythree patients, 31 men and 22 women, underwent fibula osteocutaneous free flap harvesting between february 1992 and january 1997. Its indicational spectrum, therefore, reaches from bony reconstruction at the extremities to replacement of the whole mandible, including closure of large perforating defects of the oral cavity. To our best knowledge, this is the first case series exclusively dedicated on. A new procedure assisted by digital techniques for secondary mandibular reconstruction with free fibula flap yao yu, md, wenbo zhang, md, xiaojing liu, md, chuanbin guo, md, phd, guangyan yu, md, dds, and xin peng, md, dds purpose. Microvascular free tissue transfer allows one to transfer wellvascularised, bone containing flaps for oromandibular and midface reconstruction.
The use of free flaps containing a bony component is reportedly the best technique to. The layered fibula osteocutaneous flap sets new standard. Free fibular flap transfer for mandibular defects in head and neck cancer patients is widely performed. Indications the free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios 1. Preoperative virtual planning was used more often for the second fibula flap compared with the first 50 percent versus 10 percent. The flexibility of the fibula in threedimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. Functional mandibular reconstruction with doublebarrel fibular. Unsubscribe from microsurgery made easy cancel unsubscribe.
Vascularised free fibula flap fff technique in head and neck. Ct angiography may be used preoperatively to evaluate the vascular supply of the lower leg prior to free fibula flap harvest. Reconstruction of the mandible by fibula free flap eyal gur md and aharon amir microsurgery unit, department of plastic and reconstructive surgery, elt aviv sourasky medical center, elt aviv, israel key words. The fibula free flap has been advocated for reconstruction of lower palatal and alveolar defects with the advantage of allowing for osseointegrated dental implants. Mandibular reconstruction using fibula free flap harvested. Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. Mandibular reconstruction with a microvascular free fibula flap mff is an elegant solution to restore the anatomic. Our experience suggests that mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 disease. Pdf donor leg morbidity and function after fibula free flap. They lost blood flow two days later and tried to salvage the flap.
It is articulated superiorly with the lateral tibial. It is a composite flap and comprises muscle, overlying fascia and skin. The role of cta in the preoperative workup of free fibular. As with any free flap, complications may be divided into donor and recipient site problems. The fibula free flap provides a strong long segment of bone and can include a large fasciocutaneous component as well.
Vasconez editorial comment the way to go in bony mandibular reconstruction. A fibular free flap is one way of filling a bony hole in either the upper or. The transfer of the osseofasciocutaneus fibula free flap has become a routine procedure in the reconstruction of comprehensive orofacial defects. Sep 19, 2018 as with any free flap, complications may be divided into donor and recipient site problems. Vascularized fibula flaps for mandibular reconstruction. 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. At least two osteotomies were performed on each graft, and miniplates were used for. For decades, osseous vascularised flaps has been used for mandibular reconstruction with the vascularised fibula flap vff remaining the commonly used osseous free flap. The purpose of this study was to describe the computerassisted mandibular reconstruction procedure adopting the customized solution synthes proplan cmf. If you have any other questions that the leaflet does not answer or would like further explanation please ask. Free fibula flap is routinely used for mandibular reconstructions. Fibula free flap and mandibular reconstruction pocket. Stepbystep surgical technique for mandibular reconstruction.
Loss of the skin graft or a portion thereof is possible. Review of 60 consecutive fibula free flap mandible reconstruction. The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. Quizlet flashcards, activities and games help you improve your grades. Microsurgery double free flap with fibula and alt head. 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.
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. To our best knowledge, this is the first case series exclusively dedicated on fff conducted in community hospitals. Aug 17, 2015 the fibula free flap has been advocated for reconstruction of lower palatal and alveolar defects with the advantage of allowing for osseointegrated dental implants. Bone reconstruction, maxillary reconstruction, fibula free flap. Besides its length, major advantages of the fibula free flap include the trigonal diameter of the fibular bone, which usually allows the placement of dental implants. Besides its length, major advantages of the fibulafree flap include the trigonal diameter of the fibular bone, which usually allows the placement of dental implants. According to us, fibula free flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. It is one of the common ways of replacing bone that has been removed for cancer treatment. Its indicational spectrum, therefore, reaches from bony reconstruction at the extremities to replacement of the whole mandible, including closure. 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. The neurocutaneous free fibula flap in mandible reconstruction.
Please be advised that this video contains graphic footage of surgery. Midface reconstruction with the fibula free flap facial plastic. Drains are used in the leg until output is sufficiently low for removal. Reconstruction of premaxilla with fibula free flap article in journal of craniofacial surgery 186. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap. Vascularised fibula flaps for mandibular reconstruction. Jan 05, 2015 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. 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.
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