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PubMed1998

[The reconstruction of mandible and soft tissue defects with the osteocutaneous free fibula flap].

OBJECTIVE: To find a new material to reconstruct the defects involving mandible and the surrounding soft tissues with the donor site morbidity mild and transient. METHODS: Ten consecutive fibula free flaps were used to reconstruct composite defect of mandible and soft tissue. The average length of the fibular graft was 9.1 cm, and the average size of the cutaneous-flap was 4.5 cm x 6.2 cm. RESULTS: 99mTcO4- scan demonstrated that 9 flaps were survivial (9/10) 2 weeks postsurgery. The function and the contour of the mandible were excellent. The donor site morbidity was mild and transient. CONCLUSION: Fibula has a high density of cortical bone. There is enough bone available to reconstruct mandible defect. The osteocutaneous fibula flap is a new material to reconstruct the composite mandible and soft tissue defects.

Adult↗
PubMed1999

[Application of repairing tibia and soft tissue defect with free fibula combined tissue grafting].

OBJECTIVE: To investigate a good method for repairing the long bone defect of tibia combined with soft tissue defect. METHODS: From 1988-1998, sixteen patients with long bone defect of tibia were admitted. There were 12 males, 4 females and aged from 16 to 45 years. The length of tibia defect ranged from 7 cm to 12 cm, the area of soft tissue defect ranged from 5 cm x 3 cm to 12 cm x 6 cm. Free fibula grafting was adopted in repairing. During operation, the two ends of fibular artery were anastomosised with the anterior tibial artery of the recipient, and the composited fibular flap were transplanted. RESULTS: All grafted fibula unioned and the flap survived completely. Followed up for 6 to 111 months, 14 patients acquired the normal function while the other 2 patients received arthrodesis of the tibial-talus joint. In all the 16 patients, the unstable ankle joint could not be observed. CONCLUSION: The modified method is characterized by the clear anatomy, the less blood loss and the reduced operation time. Meanwhile, the blood supply of the grafted fibula can be monitored.

Adolescent↗
PubMed2002

[The utility of vascularized free fibula flap in mandibular reconstruction: a clinical report of 25 cases].

OBJECTIVE: The purpose of this study was to evaluate the advantages and disadvantages of vascularized free fibula flap as a new method for mandibular reconstruction. METHODS: 25 cases (17 male to 8 female) who have received mandibular reconstruction with free vascularized fibular flaps in our hospital were studied retrospectively. The average length of the fibula grafts is 10.0 cm (range from 5.5 to 16 cm). 3 cases received primary insertion of osteointegrated dental implants into the free fibula flap, and all these 5 implants survived. RESULTS: All flaps except 1 were viable. 62% of the cases took normal diet postoperatively, and the remainder took soft diet as well. All patients spoke clearly. No ankle unstability was reported. And the aesthetic assessments in all patients were good or fair. CONCLUSION: Vascularized free fibular flap takes its distinct advantages to other autogeneous free bone flaps and is confirmed to be one of the optimal methods for mandible reconstruction by our study.

Adolescent↗
PubMed2003

[Treatment of benign bone tumor in extremities of children by subperiosteal free fibula graft].

OBJECTIVE: To investigate the way to reconstruct bone scaffold after removal of giant benign bone tumor in extremities of children. METHODS: From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 6-14 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia (1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. RESULTS: After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired, and the function of ankle joint returned normal. CONCLUSION: Autograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.

Adolescent↗
PubMed1992

[Mandibular reconstruction by free transfer of the fibula after cancer excision].

The authors present five cases of mandibular reconstruction using a vascularised fibula free transfer in cases of mandibulectomy for cancer. After giving a short account on the anatomy, they describe the technical details of fibula preparation and its transfer at the recipient site. The clinical observations are described. This recent technique seems to be developing, taking in account the qualities of the fibula: available bone length, possibility of performing osteotomies with preservation of the vascular supply, low morbidity at the level of the donor site, and satisfactory cosmetic and functional results. Despite of one recent failure, this short series seems to confirm the great interest in this type of bone reconstruction.

Adult↗
PubMed1992

[Free composite flaps with the fibula and their adaptation to mandibular reconstructive surgery. Apropos of 9 cases].

Although revascularized fibula bone transfers have been used in reconstructive surgery of long bones for about fifteen years, the first reported cases of mandibular reconstruction were only published in 1989 by Hidalgo. The mandible and the fibula actually have very few points in common apart from their respective length and a certain similarity of cross-section. However, free composite flaps including the fibula are adapted to reconstruction of the mandible for several reasons: the length of the bone which can be raised (25 cm) and osteotomized into several fragments; the addition of other components (skin, aponeurosis, muscle, etc.) for skin and/or mucosal repair; the spatial independence of these various elements; the microsurgical qualities of the peroneal artery. This possibility of multidirectional and multiple tissue bony mandibular reconstruction is analysed on the basis of 9 clinical cases: 5 cases of traumatic sequelae of the lower third of the face following gunshot injuries, 2 cases of radiation osteonecrosis, 2 benign bone diseases. The triple bone, integument and vascular adaptation between the fibular donor site and the recipient site must be assessed preoperatively. Due to the quality of the morphological and functional results compared with the limitations of other free composite bone transplants, the authors propose free composite fibular flaps as adapted and adaptable solutions for one-stage reconstruction of extensive mandibular defects (> 10 cm) associated with small or large mucocutaneous lesions.

Adult↗
PubMed2003

[Speech outcomes in patients of maxillary reconstruction with free fibula composite flap].

OBJECTIVE: To evaluate speech outcomes in patients of maxillary reconstruction with free fibula composite flap. METHODS: Speech measurements of 20 patients of maxillary reconstruction with free fibula composite flap were collected. Palatopharyngeal valve, the symmetry and movement of soft palate, hypernasality and nasal emission were examined by nasoendoscopy. At the same time the speech intelligibility was measured. RESULTS: No palatopharyngeal valve insufficiency was found and all the soft palates had good symmetry and movement. The average speech intelligibility was 98.4%. CONCLUSIONS: Free fibula composite flap can reconstruct the phonatory structure and support the function of soft palate, which can restorate speech function well. It is a good choice for maxillary reconstruction.

Adult↗
PubMedDate not supplied

The role of vascularized fibula in skeletal reconstruction.

Since March 1988, 144 oncologic bone resections have been surgically treated with vascularized fibula (VF). In 30 patients VF was used after the failure of previous reconstructions, while in 114 cases (79%) VF immediately followed tumor resection. In 14 cases VF was pedicled on its vessel and used to reconstruct the ipsilateral tibia. In 17 young children, the proximal fibula was used to reconstruct with a potential growth the proximal humerus, the distal radius or the proximal femur. In 103 cases VF was combined with bone allografts. In 70 of these the fibula was inserted inside the massive allograft as a viable rod. There were 7 mechanical failures, 9 deep infections, and 10 local recurrences. According to functional evaluation, 69 patients (48%) presented with excellent functional results, 39 patients (27%) had good results while fair of poor results were recorded in 36 cases (25%).

Adolescent↗
PubMed1992

Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head.

A variety of joint-preserving operations have been devised to preserve the necrotic femoral head with varying success. Since 1979, the authors studied the effectiveness of vascularized fibula grafting in the treatment of osteonecrosis of the femoral head (ONFH) for joint preservation. Eighty-one of 121 hips with a minimum follow-up period ranged from three years to ten years eight months (mean, five years two months). All patients were evaluated clinically and roentgenographically on the basis of the causes and the stages of the disease. In the clinical assessment, 60 (74%) of 81 hips were rated excellent, 14 (17%) were rated good, six (7%) were rated fair, and one (2%) was rated poor. Overall satisfactory results, including excellent and good, were seen in 74 hips (91%). In the roentgenographic assessment, 57 hips (71%) had improved radiologically, 15 (18%) were unchanged, and nine (11%) were worse. Seventy-two hips (89%) showed roentgenographic improvement or unchange. Roentgenographic results had no significant correlation with the etiologic factors. Vascularized fibula grafting is one of the better alternatives for treating ONFH. It is highly expected that vascularized fibula grafting can prevent the necrotic femoral head from progressing to collapse and promote directly restored vascularization and new bone formation.

Adult↗
PubMed2004

Early complication following long bone reconstruction using vascularised fibula graft.

Long bone reconstruction using vascularized fibula graft is becoming more popular despite the difficulties and its post-operative complications. We reviewed our early experience dealing with vascularized fibula graft for the management of massive long bone defect. Thirteen patients had undergone long bone reconstruction using vascularized fibula graft. Early complications that had been encountered include superficial wound infection (23%), transient common peroneal nerve palsy (23%), stage 1 bed sore (7.7%), anastomotic venous thrombosis (30.8%), DIVC (15.4%), flap loss and amputation (7.7%), and reactive psychiatric problem (7.7%). The early complications following this procedure are comparable with other major orthopaedic surgery and most of them are minor and treatable. The complication rates are also comparable with similar surgery done elsewhere.

Adolescent↗
PubMed2004

Fibula free flap for mandible reconstruction.

OBJECTIVES: Microvascular mandibular reconstruction should be considered the procedure of choice for bone replacement in radiated tissue beds, orocutaneous fistulae with segmental bone loss, osteoradionecrotic mandibles, and for immediate composite tissue reconstruction. The free vascularized fibula has significant potential for the reconstruction of the mandible. We evaluated our clinical experience in 21 cases of mandible reconstruction with fibular flaps. PATIENTS AND METHODS: Between 1997 and 2002, we performed 7 free osseous fibula flaps and 14 osteocutaneous fibula flaps for a total of 21 mandible reconstructions in 21 patients (8 females, 13 males; mean age 41 years; range 22-58 years). Indications for mandibular resection were squamous cell carcinoma of the floor of the mouth, tongue, oropharynx, and/or alveolar ridge in 13 cases, ameloblastoma of the mandible in 4 cases, leiomyosarcoma of the mandible in 2 cases, and chondrosarcoma of the mandible in one case. There was a traumatic loss in one case. Of 21 patients, 17 were reconstructed primarily, and 4 patients had secondary reconstruction. RESULTS: All flaps, except one, survived and their viability was confirmed by scintigraphy when available. The skin defect in this patient was repaired by local lip flap which needed commissurotomy later, but the patient refused bone reconstruction. In two cases, because of long-lasting orocutaneous fistula and saliva drainage without flap loss, we used a pectoralis major pedicled flap as a secondary procedure. In three cases, donor side skin healing problems were managed well by secondary intention or split-thickness regrafting. Two patients had temporary foot drop which recovered in an average of three months. Simple problems with wound healing such as dehiscence and delayed healing developed in five patients, which usually required only local antiseptic treatment. After the operation, patients began oral feeding and walking with crutches in the third week, adjuvant radiotherapy began in the 6th week, and walking without crutches in the eighth week. CONCLUSION: Fibular bone allows to plan osteotomies in relation to the orientation of the bone and its vascular pedicle. Thick cortical bone readily accepts plates and screws for a secure interosseous fixation and osteointegrated implants may be placed in this bone safely. Among other alternatives like scapular and crista ilaca flaps, fibular flap has many advantages for mandible reconstruction and represents the first choice for the head and neck surgeon.

Adult↗
PubMedDate not supplied

Implant prosthodontic rehabilitation of fibula free-flap reconstructed mandibles: a Memorial Sloan-Kettering Cancer Center review of prognostic factors and implant outcomes.

PURPOSE: This study aimed to estimate the cumulative survival rates (CSRs) of implants placed in reconstructed mandibles and to identify prognostic factors that may influence implant survival. MATERIALS AND METHODS: The charts of 24 patients (10 male, 14 female) who had undergone mandibular resection and reconstruction with fibula free-flaps treated with implant-supported prostheses from April 1986 through December 2001 were reviewed. Information on demographics, surgical characteristics, treatment modalities, dentition, implant parameters, prostheses, and hyperbaric oxygen therapy (HBO) was gathered. Kaplan-Meier survival estimates were generated for the 100 implants that satisfied the inclusion criteria. Multivariate Cox proportional hazards regression models accounting for correlated implants within subjects were developed to identify prognostic factors for implant survival. RESULTS: Ninteen implants had been placed in native mandible (3 in irradiated bone) and 81 in fibula bone flap. Six implants failed during the follow-up period (mean 51.7 months). The overall 5- and 10-year CSRs were 97.0% and 79.9%, respectively. In the univariate analysis, variables associated with implant survival were age, gender, chemotherapy, radiation therapy, HBO, irradiated bone, implant diameter, xerostomia, trismus, opposing dentition, and type of prosthesis. At 5 years, the CSR of implants in patients with HBO was 86.7%; HBO was statistically associated with an increased risk for implant failure (P = .005, hazard ratio = 19.79, 95% CI: 2.42 to 161.71). DISCUSSION: The CSR was lower when implants were placed in a previously irradiated mandible. There is still a lack of reliable clinical evidence to support the effectiveness of HBO in these patients. CONCLUSIONS: A high survival rate was demonstrated for implants placed in fibula free-flap reconstructed mandibles. The finding that HBO was a risk factor can probably be attributed to the small sample size; further study is needed in this patient population.

Adolescent↗
PubMed1991

[Mandibular reconstruction using free vascularized fibula transplant].

Free revascularized fibular transplants have been used in surgery for the reconstruction of long bones since 1973. The reconstruction of the mandible using a free fibular transplant has been published in 1989 only by Hidalgo. The mandible and the fibula have little in common, except for their length and a similar structure in section. The anatomical study of the free osteofasciocutaneous fibular graft included 20 fresh subjects. The vascularization of the fasciocutaneous plate is either grouped or, more frequently, tiered (2/3 of cases). The technique to remove this graft is specified. Four clinical cases are reported, including three cases of neoplasm of the floor of the mouth invading the mandible, and one case of traumatic amputation of the lower part of the face. A free composed transplant taken from the fibula has been used in all four cases. The postoperative period was normal, and the grafts were completely successful. The main indications of free transplants made of fibular bone are: extensive (more than 8 cm) or compound losses of bony substance from the mandible. The richly vascularized transplant take from the fibula is very sophisticated and performant. The length of bone that can be removed is 25 cm; the bone may be osteotomized in 2 to 4 fragments retaining their vitality. Other tissular structures such as the skin, fascia, muscle, are removed with the bone. The independence in space is threefold and regards the bone, the teguments and the vascular pedicle. The microsurgical qualities of the vascular pedicle are considerable. These free transplants improve the quality of survival (endosseous implants in one case). The morphological, functional and esthetic result is good as a rule.

Adult↗
PubMed1991

Congenital pseudarthrosis of the forearm and fibula. A case report.

Congenital pseudoarthrosis of the ulna and contralateral fibula occurred in a seven-year-old boy. Multiple limb involvement is extremely rare and has only been reported involving the tibia and fibula. Congenital pseudarthrosis of the tibia is a well-known entity, with other bones affected much more rarely. A case is reported involving the ulna and the contralateral fibula. This appears to be the first case of congenital pseudarthrosis reported involving an upper and a lower limb.

Child↗
PubMed1991

The effects of resection of the proximal part of the fibula on stability of the knee and on gait.

We studied six patients to determine the effects of unilateral marginal resection of the proximal part of the fibula on stability of the knee and on gait. At the time of the operation, the fibular collateral ligament and the tendon of the biceps femoris were reattached, but no attempt was made to stabilize the fibula otherwise. The patients were tested an average of sixty-one months after operation. Stability of the knee was measured with an instrumented system. Gait was evaluated with an optical electronic three-dimensional digitizing system and a multicomponent force-platform. The gait of six healthy control subjects of similar age was also studied, and the reproducibility of measurements of stability of the knee was investigated in four healthy adults. There were significant differences between the side on which an operation had been done and the contralateral side with regard to the extent of anterior translation and of total anterior-posterior translation of the tibia at both 20 and 90 degrees of flexion of the knee, and in total varus and valgus rotation of the knee (the number of degrees from a position of maximum varus to one of maximum valgus angulation) at 20 degrees of flexion. The measurements of gait and of motion of the knee were found to be normal when compared with those in the control subjects. In the ground-reaction measurements, there were some significant differences from normal in the medial-lateral plane, but they were clinically unimportant. Resection of the proximal part of the fibula can lead to instability of the knee.

Adult↗
PubMed1985

[Dislocation of the head of the fibula--diagnostic and therapeutic problems].

Luxation of the head of the fibula in the proximal tibiofibular joint is rare and is often overlooked. Pointers in this direction should be a swelling above the head of the fibula that is sensitive to pressure, an inexplicable pattern of signs involving the fibula, as well as an undefined insecurity of gait associated with the absence of other injuries in the genicular area. Diagnosis is best confirmed in the hospital by means of luxation or repositioning manoeuvres at the joint. The experienced physician can draw further conclusions from x-ray films of the forced extreme joint position. Therapy depends exclusively on the severity of complaints of the patient and must be determined individually for each patient.

Adult↗
PubMed1978

["Fibula-pro-tibia-fusion" (Hahn-Brandes-Graft) in treatment of bone defects of the tibia (author's transl)].

The authors use the "fibula-pro-tibia fusion" (also called Hahn-Brandes Graft, for the treating large bone defects of the tibia shaft. This method is preferred both with congenital partial tibial aplasias with acquired extensive pseudarthrosis defects of the tibia. In congenital cases, grafting of the distal end of the fibula onto the calcaneal end of the foot with careful preservation of the epiphyseal disc, should precede surgery. Large differences in leg length can be treated after fusion surgery by means of elongation osteotomies. Attention is drawn to this method in the second example of pseudarthrosis defect. Lastly the authors mention a further method for mediation of large diaphyseal tibia defects, namely the transplantation of the opposing fibula. This can lead to good results when an aggressive form of fibrous dysplasia is not present, as was the case however in the third example. In such a case the process only heals after removal of the cover of the periosteum as well.

Adult↗
PubMed1984

Surgical management of aggressive and malignant tumors of the proximal fibula.

En bloc resection of tumors of the proximal fibula by a specified route allows safe exposure of the popliteal vessels and resection of the fibula, tibiofibular joint, and adjacent musculature. Type I (marginal excision) and Type II (wide intracompartmental resection) procedures performed in ten consecutive patients were evaluated. There were five male and five female patients; the average age was 18.9 years. The histologic diagnoses were osteosarcoma (2 patients), Ewing's sarcoma (3 patients), aggressive osteoblastoma (1 patient), giant cell tumor (3 patients), and "active" osteochondroma (1 patient). All resections achieved negative margins, with no local recurrences from 14 to 37 months after operation. Pathologic specimens showed a high incidence of direct muscle infiltration. Local complications included peroneal palsy (2 patients), flap necrosis (2 patients), and synovial fistula (1 patient). No secondary surgical procedures were required. At follow-up evaluation no knees showed ligamentous instability, and ankle function was good. Selected patients with aggressive (benign) and malignant tumors of the proximal fibula can be treated successfully by resection. A good functional outcome can be anticipated.

Adolescent↗