Patients will be in the icu for 24 days and are usually sedated asleep for 2448 hours. Review of 60 consecutive fibula free flap mandible reconstruction. Mandibular reconstruction using fibula free flap harvested using a. May 05, 2016 fibula osteocutaneous free flap dissection surgical video. The fibula from the same side of the body as the tumor is selected for harvesting. Harvesting the cutaneous skin paddle and a longer piece. At this point, the interosseous septum is encountered. A fibular free flap is one way of filling a bony hole in either the upper or lower jaw. Mandibular reconstruction with a microvascular free fibula flap mff is an elegant solution to restore the anatomic. 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. Virtual planning and guided surgery in fibular freeflap mandibular.
So, back into surgery he went five days later using the. The bone may be taken from your fibula, which is the smaller of. Reconstruction and masticatory rehabilitation of a bilateral. 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. Midface reconstruction with the fibula free flap facial plastic. Using a second free fibula osteocutaneous flap after. Fibula osteocutaneous free flap dissection video youtube. Fibula free flap in the treatment of mandibular osteoradionecrosis.
The purpose of this study was to describe the computerassisted mandibular reconstruction procedure adopting the customized solution synthes proplan cmf. You may have a mandibulectomy if you have a tumor involving your jaw. Vsp reconstruction order form for reconstruction using fibula free flap the pedicle will emerge from. If your jaw is being rebuilt using bone from a different donor site or. Pdf evaluation of fibula free flap donor site morbidity. It is one of the common ways of replacing bone that has been removed for cancer treatment. The free vascularised fibular flap fvff is widely used to treat bone defects, although it must be harvested from a healthy site. Analysis of the compatibility of dental implant systems in. The initial use of free fibular flap was limited to the reconstruction of long bone defects of the extremities until 1989, where this flap was used for.
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. Fibula free flap exercise and therapies department advice. Data were collected from medical files, imaging and photographic data. When a fibular flap is planned, it is very important to decide where the mandible should be osteotomized, where the fibula should be cut, and how accurately the surgery should be performed. Perioperative reconstructive complications in 400 free flap. The template dark blue includes sleeves that wrap around the fibula, and small sheets upright squares that indicate the cutting angles. Fibula free flap in mandibular reconstruction request pdf. The study reports five consecutive patients with benign or malignant disease requiring. The lateral arm flap in 1982, song and coworkers introduced the free lateral arm flap18. It has the advantages of consistent shape, ample length, distant location to allow a twoteam approach, and low donorsite morbidity. It can be used as a sensate flap andor as a carrier for a vascularised nerve graft. Once the bone is raised it is transferred to the head and neck and secured in position with small plates and screws.
The neurocutaneous free fibula flap in mandible reconstruction. Mandible reconstruction with free fibula flap plastic. A the fibula cutting guide template was prepared, based on the computeraided design of a mandibular reconstruction with the fibula. With lateral retraction of fibula, begin anterior dissection of muscle off of fibula leaving 1 to 2 mm cuff of muscle. Free fibula flap is routinely used for mandibular reconstructions. The pedicle runs the length of the fibula, with perforators extending to supply the skin paddle.
Case report mandibular reconstruction with single barrel vascular. A fibula free flap is when an area of tissue and bone is taken is taken from one of your bones in the lower leg fibula. 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 can be raised with a skin island for compositetissue reconstruction. Long term functional and esthetic outcomes after fibula free. How to harvest free fibula flap for mandibular reconstruction. 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. Fibula free flap, mandibular reconstruction, cadcam technique, cutting guide. Stepbystep surgical technique for mandibular reconstruction. Mandibulectomy and freeflap reconstruction a mandibulectomy is a surgery to remove all or part of your jaw mandible. Certain materials like for example videos or multimedia files other than.
The single fibular flap origami technique obviates a 2flap. Free vascularised fibular flap harvesting in children. Composite free fibula flap for complex defects of the. Stepbystep mandibular reconstruction with free fibula flap modelling. Our experience suggests that mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 disease. The free fibular flap is one of the most common techniques used in mandibular reconstruction after resection of a malignant tumor in the head or neck. Donor leg morbidity and function after fibula free flap. This pdf document has been automatically generated from a digital poster submitted. The lateral arm flap in 1982, song and coworkers introduced the free lateral arm flap 18. Validation of a fibula graft cutting guide for mandibular. Free fibula flap is routinely used for large jaw reconstructions 4 5. 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. 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.
Fibula free flap the leg is the donor site that is most often used for jaw reconstructions. The purpose of this study was to determine the donor leg morbidity and function after removal of the fibula free flap for. Preoperative color flow doppler imaging for fibula free tissue transfers. Dec 12, 2017 the fibula free flap fff constitutes the gold standard surgical approach for mandibular reconstruction. Your jaw may be rebuilt using bone from another part of your body the donor site. We present a series of patients who underwent fibula free flap reconstruction of the midface and evaluate the success and functional outcomes of this technique. The role of cta in the preoperative workup of free fibular. The utility of ct angiography in diagnosing vascular variations and disease is welldocumented.
Here, we aimed to establish the preplating technique. 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 fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. Pdf on jan 1, 2019, chirom a singh and others published how to harvest free fibula flap for mandibular reconstruction. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap. Osteocutaneous fibula free flap iowa head and neck protocols. Pdf how to harvest free fibula flap for mandibular reconstruction. Pdf mandibular reconstruction using fibula free flap harvested. Fibula osteocutaneous flap for mandible reconstructionafter. Sep 19, 2018 the fibula free flap provides a long, strong segment of bone for use in reconstructive surgery. The objective of this study was to assess clinical morbidity and radiological changes at the fvff donor site in children. 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. Muscles encountered will be peroneus, extensor digitorum longus, and extensor hallucis longus. May 10, 2014 at present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery.
To report functional and esthetic outcomes, after fibula free flap fff reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians and patients. About your mandibulectomy and fibula free flap reconstruction. To our best knowledge, this is the first case series exclusively dedicated on fff conducted in community hospitals. Although further investigation on this technique might be needed, this report. Apart from the surgeons comfort, the technique reduces operative time and. 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. Lowcost design and manufacturing of surgical guides for. Duplex scanning prior to fibula free flap transfers.
Pdf to evaluate foot and ankle function in a series of patients undergoing fibula microvascular free tissue transfer. Recent series of microvascular head and neck reconstruction source no. After shaping the fibula sections, the mandibular repair can be constructed using those sections, as shown in figure 6. It can be harvested as a purely osseus flap or can include a large fasciocutaneous component if needed. If you have any other questions that the leaflet does not answer or would like further explanation please ask. Mandibular reconstruction using fibula free flap harvested. Since then, the vascular free fibula flap has been widely accepted as the gold standard for largescale mandibular bone reconstruction. The three fibula sections are shown at the top of figure 7. 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. Other vascularised bone flaps used in the head and neck include iliac crest, scapula and radial forearm flaps.
Mandible reconstruction is routinely performed in highvolume academic centers. The purpose of this study was to evaluate the safety and efficacy of performing a second free fibula flap reconstruction after repeated segmental mandibulectomy. Sep 23, 2016 the most feared donor site complication in fibula flap harvest is foot ischemia secondary to sacrifice of the peroneal artery. You will have a breathing tube and will be on a ventilator for 24 48 hours. The leg is the donor site that is most often used for jaw reconstructions. Importance bisphosphonaterelated osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy. 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. All patients who underwent fibula freeflap mandibular reconstruction between. Original article analysis of outcome and complications in 400.
Free fibular flap transfer for mandibular defects in head and neck cancer patients is widely performed. 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. Microanastomosed osteomyocutaneous fibula free flap fff, first described in 1989 by hidalgo, is the technique of choice for mandibular reconstruction 1, 2, 3. Case report mandibular reconstruction with single barrel. Angioct preoperative planning of inferior limb free flaps in. Pdf free fibula flap is routinely used for mandibular reconstructions.
Donor site morbidity of the fibula free flap has been evaluated in a large series of orthopedic patients. This can be considered a safe surgical procedure even in elderly head and neck cancer patients 1. Dicom format data were processed by the surgeons using cmf software. 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. An artery, vein, and soft tissue will also be removed with the bone. Angioct preoperative planning of inferior limb free flaps. Donor site morbidity is low and its location facilitates the 2 team. B the fibula cutting guide template was fixed to the intact fibula. Jun 26, 2016 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.
This flap is often used to reconstruct areas in your mouth that require. A004 wwu solid freeform fabrication assisting free fibula. Dicom format data were processed by the surgeons using. A onestage, threedimensional planned microvascular fibula free flap reconstruction after cancer resection in combination with postoperative implant placement and vestibuloplasty is a clinically valuable treatment concept even in older patients to restore function and facial contours. They lost blood flow two days later and tried to salvage the flap.
Surgery went well, except that his arteries were severely damaged from radiation, and the surgeons had difficulty getting good blood flow to the flap. Ant left post right check all that apply guide design speci. The role of cta in the preoperative workup of free fibular flap. Ct angiography may be used preoperatively to evaluate the vascular supply of the lower leg prior to free fibula flap harvest. The fibula was investigated as a donor site for freeflap mandible reconstruction.
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