Pdf at present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after. Osseointegrated dental fibula free flaps for mandibular. The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. The application of fibular free flap with flexor hallucis. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. The utility of ct angiography in diagnosing vascular variations and disease is welldocumented. Patients will be in the icu for 24 days and are usually sedated asleep for 2448 hours. The free fibula flap has become the gold standard for reconstruction of the mandible in several clinical scenarios.
Download as an information leaflet pdf fibular free 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. 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. This fibula free flap fff has recently become a more and more popular.
Excellent height and contour for the reconstruction of the jawbone. 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. The fibula free flap has been advocated for reconstruction of lower palatal and alveolar defects with the advantage of allowing for osseointegrated dental implants. These include ample bone length, ease of flap dissection and shaping with less blood loss, a possibility of 2 team. Request pdf fibula free flap the fibula is a bone located in the lateral portion of the leg measuring approximately 40 cm. The goal of this study is to report functional and esthetic outcomes, after fibula free flap fff reconstruction of the mandible for oral cancer, assessed by. Using a second free fibula osteocutaneous flap after. The pedicle runs the length of the fibula, with perforators extending to supply the skin paddle. The patient is positioned supine on the operating table with the hip and knee slightly flexed and internally rotated and maintained in that position. There are unique advantages to using the fibula for reconstructive surgery, including. The fvff technique was first developed by taylor et al.
The neurocutaneous free fibula flap in mandible reconstruction. The technique allows for anatomic perforator localization during the. 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. Mandibular reconstruction continues to be one of the most common surgical challenges faced by oral and maxillofacial surgeons. Harvesting the cutaneous skin paddle and a longer piece. Microanastomosed osteomyocutaneous fibula free flap fff, first described in 1989 by hidalgo, is the technique of choice for mandibular reconstruction 1, 2, 3. Your jaw may be rebuilt using bone from another part of your body the donor site. The fibula free flap provides a long, strong segment of bone for use in reconstructive surgery.
Here, we aimed to establish the preplating technique for oromandibular reconstruction in a stepbystep fashion, based on 41 patients. Advancing education, research, and quality of care for the head and neck oncology patient. We herein report dental rehabilitation of a free fibulareconstructed mandible with scar contracture. Twenty patients underwent a second free fibula flap reconstruction after a second mandibulectomy.
Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. Preoperative virtual planning was used more often for the second fibula flap compared with the first 50 percent versus 10 percent. Fibula free flap was first described by taylor and colleagues in 1975 1, and then hidalgo 2 introduced it for mandibular reconstruction in 1989. Computed tomographic angiography perforator localization for. Free fibular flap transfer for mandibular defects in head and neck cancer patients is widely performed.
An artery, vein, and soft tissue will also be removed with the bone. 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. 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 osteocutaneous free flap harvest american head. To improve the use of fff, we add the flexor hallucis longus. Surgical design and simulation sds is a useful tool to help surgeons visualize the anatomy of the patient and perform operative maneuvers on the computer before implementation in the operating room. Review of 60 consecutive fibula free flap mandible reconstruction. Rashid m, ahmad t, ansari tn, ahmed b, ahmed s, et al. Fibula osteocutaneous free flap dissection video youtube. This can be considered a safe surgical procedure even in elderly head and neck cancer patients 1. Stepbystep mandibular reconstruction with free fibula. It has the advantages of consistent shape, ample length, distant location to allow a twoteam approach, and low donorsite morbidity. A fibular free flap is one way of filling a bony hole in either the upper or lower jaw.
Osteocutaneous flap an overview sciencedirect topics. Ct angiography may be used preoperatively to evaluate the vascular supply of the lower leg prior to free fibula flap harvest. Wed like to understand how you use our websites in order to improve them. The present benchtop study was intended to identify if there is a. Not a fork of opentibia, although i am also an opentibia developer. Fibula osteocutaneous free flap dissection surgical video. The study reports five consecutive patients with benign or malignant disease requiring. Condyle dislocation following mandibular reconstruction. 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. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction.
The most commonly affected areas are the head, the neck and the trunk. 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. About your mandibulectomy and fibula free flap reconstruction. All patients who underwent fibula freeflap mandibular reconstruction between 20 and 2014 in our institution were. 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 fibula free flap has sufficient bone stock to span large segmental mandibulectomy defects and support osseointegrated implants. While these technologies have many advantages, further evidence of their potential to improve outcomes is required. 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 fibula free flap for postresective reconstruction of the mandible. 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.
Osteocutaneous fibula free flap iowa head and neck protocols. Please be advised that this video contains graphic footage of surgery. Fibular free flap how is fibular free flap abbreviated. 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. The surgical technique is discussed in a stepbystep fashion. Three different types have been reported in the literature. The latter is described first because the former does not require preservation of cutaneous perforator vessels. Fibula free flap in mandibular reconstruction atlas of the oral. The fibula free flap fff is one of the most widely used flaps for the reconstruction of mandibular defects caused by trauma or lesions such as tumors 1, 2.
The fff has several advantages including sufficient bone length for mandibular reconstruction, a high survival rate, and performability at the time of skin grafting 3,4,5. The fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. Mandible reconstruction with free fibula flap plastic. The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The purpose of this study was to assess and compare periimplant bone. Reconstruction of partial maxillary defects with the. Fuchan wei showed the reliability of the skin island in 1986. Free vascularised fibular flap harvesting in children. It can be raised with a skin island for compositetissue reconstruction. The layered fibula osteocutaneous flap sets new standard.
In patients undergoing either neoadjuvant or postoperative radiation. At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. Owing to recent advances in computer technology, it is now. Free and opensource clone of the mmorpg tibia, by cipsoft gmbh. 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. This pdf is available for free download from a site hosted by medknow. Mandibular reconstruction using fibula free flap harvested. Retrospective analysis of vascularised free fibula. The mucosalized muscle cuff of a boneonly fibula free flap forms a superior. The simplest technique for restoring alveolar and mandibular. Longterm results of dental implant treatment in fibula free and deep circumflex iliac artery dcia free flaps are scarce. To learn more about the department of otorhinolaryngology at mayo clinic, visit.
Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex. The role of cta in the preoperative workup of free fibular. Infantile myofibromatosis is the most common benign fibrous tumor in infants. Primary disease, type of reconstruction, defect area, fibula segment length and number of osteotomies. Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. Of all the flaps currently known, the fibula has become the technique of choice 1, 2. Reconstruction with fibular osteocutaneous free flap in.
The fibula free flap can be harvested as an osseous or osteocutaneous flap. Versatility of fibula free flap in reconstruction of. The fibula was investigated as a donor site for freeflap mandible reconstruction. Pdf stepbystep surgical technique for mandibular reconstruction.
Transfer of a free vascularised fibular flap fvff is an option for treating bone defects of 5 cm or more in children. Virtual planning and guided surgery in fibular freeflap mandibular. The fibula free flap fff has been a workhorse in maxillofacial reconstruction. Analysis of the compatibility of dental implant systems in. Reconstruction of partial maxillary defects with the doublebarrel fibula free flap. The leg is the donor site that is most often used for jaw reconstructions. If you have any other questions that the leaflet does not answer or would like further explanation please ask.
Fibula free flap fff provides several advantages over other donor sites. Pdf the reconstruction of the mandible is a complex procedure. Fibula free flap in the treatment of mandibular osteoradionecrosis. Ease of obtaining from the donor site with few side effects for the patient. Ian taylor, an australian surgeon first described the fibula as a free fl ap in 1975, and dr.
Donor site morbidity of the fibula free flap has been evaluated in a large series of orthopedic patients. Besides its length, major advantages of the fibula. If your jaw is being rebuilt using bone from a different donor site or. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and ct angiography interpretation, computerassisted design and manufacturing, and the limitations of the fibular free flap. 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. Multiple case reports have described the use of this flap to reconstruct a variety of maxillary defects. 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. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap.
A vestibuloplasty technique with application of a polyglycolic acid pga sheet is. All patients regained almost normal ambulation within a year. It can be harvested as a purely osseus flap or can include a large fasciocutaneous component if needed. Pdf mandibular reconstruction using the free vascularized. The free fibula flap fff, first described by taylor for use in lower extremity salvage 10 and then by hidalgo for mandibular reconstruction, 11 is one of the most commonly used vascularized osseous and osseocutaneous flaps. The fibula free flap was first described by taylor et. 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 conventional fff has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation.
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