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PubMed2005

Fibula flap reconstruction of the condyle in disarticulation resections of the mandible: a case report and review of the technique.

Segmental resection of the mandible with disarticulation of the temporomandibular joint is occasionally required in the management of extensive tumors. The reconstruction of these deformities is complex, frequently involves staged procedures, and may result in significant deformity and loss of function for patients. The fibula free flap has become a standard treatment option for primary restoration of segmental mandibular deformities. However, little is published about its role in reconstructing the mandibular condyle. This paper describes a simplified technique for primary reconstruction of mandibular defects, including the mandibular condyle, in disarticulation resections of the mandible utilizing the fibula free flap.

Adult↗
PubMed2006

Vertical distraction osteogenesis of fibula transplant for mandibular reconstruction: a case report.

Bone continuity defects in the mandible are caused by tumor surgery, trauma, infection, or osteoradionecrosis. Today, reconstruction of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the mandible after reconstruction is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, because it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of the patient who was referred to our clinic with a reconstructed mandible owing to a gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation.

Adult↗
PubMed2000

A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula.

OBJECTIVE: In Maisonneuve fractures of the fibula (MFF) it remains controversial whether there is an injury of the interosseous membrane (IOM) and how severely it ruptures. The author studied injuries to the IOM in MFF by MRI to elucidate this question. METHOD: Twelve patients were examined with MRI before operation. MRI examination to the leg was performed with knee coil in 2 steps to obtain a complete image of the IOM. Using axial scan, we took T1 (TR500/TE40 msec), T1STIR and T2 sequence. The asymptote side was also examined in three patients as a comparison. RESULT: IOM was ruptured in a range of 32-112 mm, on average 79 mm proximal to the talar dome in all 12 patients. No IOM rupture was found at the level of high fibular fractures. IOM usually orients at the site 30 mm proximal to the talar dome. Anatomy and rupture of IOM are clearly visualized with T1 (TR500/TE40 msec) STIR sequence; haemorrhage and oedema would be seen better on a T2 image. CONCLUSION: The injury level of IOM in MFF is only at the distal 1/3 part of the leg; it is not consistent with high fibular fractures. MFF is a special type of pronation-external rotation type, there are four stages in the classification of MFF: 1) injury of medial structures, including medial malleolar fracture or rupture of the deltoid ligament; 2) rupture of the anterior tibiofibular ligament or avulsion fracture of one of its bone insertions, or one associated with interosseous ligament rupture and partial rupture of IOM in the distal 1/3 of the leg; 3) fracture of the proximal part of the fibula; 4) avulsion fracture of the posterior tibial tubercle.

Adolescent↗
PubMed1997

The free fibula bone graft for salvaging failed mandibular reconstructions.

PURPOSE: The purpose of this study was to determine the efficacy of vascularized free fibula bone grafts for mandibular salvage reconstruction. PATIENTS AND METHODS: Seven patients had fibula grafts after failed attempts at mandibular reconstruction. The prior attempts involved 20 operative procedures. Four of the seven patients (57%) had a history of radiation to the affected mandible. Bony defects averaged 10.2 cm (range, 4.5 to 24 cm), and the associated soft tissue defects averaged 6 x 12 cm. Average follow-up was 16 months. Cosmetic (facial symmetry) and functional (speech quality, oral continence, deglutition, donor site morbidity, dental rehabilitation) results were evaluated by questionnaire and clinical examinations. RESULTS: Soft tissue coverage and mandibular restoration were successful in all patients, and flap survival was 100%. Five of the seven patients (70%) achieved good or excellent functional results, and five of seven (70%) achieved good or excellent esthetic results. Complications were minimal, and the average hospital stay was 14 days. CONCLUSIONS: When the initial attempt at mandibular reconstruction is unsuccessful, mandibular function and esthetics can be salvaged with reliable vascularized soft tissue and bone flaps. As long as appropriate flap options are considered and the patient is medically stable, successful mandibular reconstruction should be achievable despite the number or cause of prior failed attempts.

Adult↗
PubMed1997

Advantages and limitations of the fibula free flap in mandibular reconstruction.

PURPOSE: The authors analyze the advantages and disadvantages of mandibular reconstruction with a fibula free flap in a retrospective study of 29 cases, and make comparisons with the iliac free flap and the lateral brachial free flap. MATERIAL AND METHODS: Twenty-nine patients (22 male, 7 female) aged 5 to 70 years were studied. Functional and esthetic evaluations were performed together with radiologic examination of the bony calluses. RESULTS: The fibula free flap has advantages for mandibular reconstruction, such as the length of bone available, low morbidity of the donor site, and the possibility of using a skin paddle. However, there is the disadvantage of not being able to reconstruct large soft tissue defects. In addition, bone vascularization is reduced when a large number of osteotomies are required. CONCLUSION: This reconstruction technique is satisfactory for mandibular defects measuring over 20 cm.

Adolescent↗
PubMed2000

Loss of fibula in mice overexpressing Hoxc11.

This study demonstrates severe malformations of the appendicular skeleton in mice overexpressing Hoxc11. Consistent with the endogenous expression pattern, the most conspicuous defect in Hoxc11 overexpressing neonates is aplasia/hypoplasia of the fibula. This is preceded at day 15.5 of embryonic development by marked reduction of chondrocyte proliferation, lack of PTHR expressing prehypertrophic cells, and the absence of hypertrophic and calcifying chondrocytes. Combined with the lack of an overt phenotype in the majority of Hoxc11 overexpressing embryos at day 13.5, the data suggest inhibition of chondrocyte differentiation during the elongation phase of the fibula bone as a primary effect of elevated Hoxc11 expression. This interpretation is further corroborated by Hoxc11 reporter gene expression in the joint areas at embryonic day 15.5, suggesting an involvement of the periarticular perichondrium in generating the mutant phenotype.

Animals↗
PubMed1998

Blood supply of small fibula segments: an experimental study on human cadavers.

When vascularized fibula grafts are used in mandibular reconstruction, it is often necessary to divide the graft into segments so as to follow the mandibular curvature. The periosteal blood supply to the segments is usually sufficient. It is unclear, however, how short the segments can be without compromising the blood supply. The present study sought to clarify this issue by injecting Indian ink into the afferent vessels in human cadavers. The evaluation of 300 specimens showed the ink perfusion to be significantly higher in segments longer than 1 cm than in shorter segments. Furthermore, the perfusion in the cortical outer third of the shaft was markedly higher than in the cortical inner two-thirds. The staining was significantly more intense in the younger (32-55 years) than in the older (56-73 years) age group. With correct dissection and successful anastomosis, however, fibula segments 1 cm or longer are probably sufficiently perfused, independent of the patient's age. The perfusion in shorter segments is uncertain. Clinically this means that segments shorter than 1 cm ought to be used only in a surgically non-compromised recipient site, where they could also take as non-vascularized grafts.

Adult↗
PubMed1998

Compartment syndrome in a free fibula osteocutaneous flap donor site.

Donor site morbidity for free fibula microvascular flaps is generally reported to be low and considered to be minor. We describe a case where the major complication of compartment syndrome occurred in a 15-year-old boy when the donor site defect was closed primarily after taking a skin paddle with a width of 4 cm. We recommend that when harvesting free fibula flaps in children, skin grafting of donor site should be considered irrespective of the width of the flap, if there is any doubt about the tightness of the closure.

Adolescent↗
PubMed2003

The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction.

According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.

Bone Transplantation↗
PubMed2000

Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report.

The authors report a case of vertical distraction osteogenesis of a free revascularized fibula flap used to reconstruct an hemimandible lost as a result of a gunshot injury. The reconstruction procedure and the distraction protocol are described; clinical and radiological results are presented. The vertical discrepancy between the fibula and the native right hemimandible was corrected.

Adult↗
PubMed2001

One-bone forearm formation using vascularized fibula graft for massive bone defect of the forearm with infection: case report.

Massive long-bone defects of greater than 6 cm are difficult to treat with conventional bone grafts, and other methods are sometimes recommended, such as vascularized bone grafts or bone transport using the Ilizarov external fixator. The combination of local infection with a massive bone defect exacerbates the problem, and provides an even more negative prognosis. The authors treated a large bone defect of the forearm with local infection, using a one-bone forearm formation with a large vascularized fibula graft. They attached an adequate amount of muscle fascia to the vascularized fibula, which was useful not only for coverage of the skin defect, but also for treatment of the local infection. Twenty months after surgery, elbow and hand functions were maintained, and the patient had no disturbance of hand function in daily activities, although rotation of the forearm was sacrificed.

Bone Wires↗
PubMed2003

Use of the free fibula flap for restoration of orbital support and midfacial projection following maxillectomy.

A total maxillectomy defect, if left unreconstructed or if poorly reconstructed, can lead to enophthalmos, orbital dystopia, feeding and speech problems, and loss of midfacial projection and vertical facial height. When the eye is preserved, despite resection of the supporting infraorbital bone during maxillectomy, bone reconstruction needs to be considered, using a vascularized bone flap. The authors have used the free fibula flap to simultaneously provide orbital support and restore midfacial projection in three patients, following total maxillectomy without orbital exenteration. For large maxillectomy defects with insufficient bony support, a free fibula flap should be considered as a reconstructive method, to adequately restore contour and the necessary structural support, and to provide optimal aesthetic and functional results.

Carcinoma↗
PubMed2006

Two-stage reconstruction in congenital pseudarthrosis of the forearm using the Ilizarov technique and vascularized osteoseptocutaneous fibula.

The authors present nine patients with congenital pseudarthrosis of the forearm. The reconstruction was carried out in two stages. At the first stage, Ilizarov's device was applied to the forearm in order to lengthen the affected extremity and to eliminate deformity. At the second stage, the bone defect was replaced a with free vascularized fibula osteoseptocutaneous graft. All patients had complete survival of the transferred fibula grafts. Bone consolidation was achieved in 4 to 6 months after the reconstruction.

Adolescent↗
PubMed2007

Does chemotherapy impair the bone healing and biomechanical stability of vascularized rib and fibula grafts?

The purpose of this study was to observe the impact of chemotherapy on the healing and biomechanical properties of vascularized bone grafts. Ten male beagle dogs were divided into two experimental groups: a chemotherapy group (CH) and control group (C). Group CH received adjuvant and neo-adjuvant chemotherapy. Each animal of both groups underwent the following operative procedures. The 5th and 7th rib were removed and replaced by vascularized pedicle transfers of the adjacent 4th and 8th rib. Additionally, a free fibular flap was elevated and retransferred to the same anatomic position. The rate of bony union on plain x-ray was 100 percent in group C, 30 percent in the vascularized rib, and 80 percent in the fibula grafts of group CH. Microangiography demonstrated no avascular bone segments in group C and in the fibula flaps of group CH. The vascularized ribs of group CH presented with 20 percent avascular bone segments. Biomechanical tests focusing on the durability of the vascularized grafts against bending and torsion forces demonstrated a reduction of the average maximum bending times by 17 percent and 23.9 percent compared to the controls ( P < 0.05). The twisting times were reduced by 13.8 percent (n.s.) and 32.5 percent ( P < 0.05). The data demonstrated a clear worsening in bone healing and stability after simulated adjuvant and neo-adjuvant chemotherapy. Thus, a large animal model was established for the further determination of the effects of chemotherapy on different vascularized bone transfers.

Angiography↗
PubMed1999

Free vascularized fibula grafts in surgery of the upper limb.

Twenty patients with intractable diseases in the upper extremity were treated using free vascularized fibula grafts. There were 13 men and seven women. Three patients had traumatic bone defects, five had post-traumatic nonunions, two had congenital pseudoarthroses, seven had defects after tumor resection, and three had other lesions. The reconstructed sites were the humerus in two patients, the radius and/or ulna in 17, and the metacarpal and phalangeal bones in one. The length of the bone defect ranged from 3 to 18 cm (mean: 8.4 cm). Follow-up periods ranged from 6 to 204 months. No patient required additional bone grafts. The mean period required to obtain radiographic bone union was 4.4 months. There were no cases with fractures of the grafted bone, but malunion occurred in four cases. The vascularized fibula graft is indicated in patients with large bone defects or intractable nonunions in the humerus, radius, and/or ulna.

Adolescent↗
PubMed1998

Simultaneous transfer of free fibula and radial forearm flaps for complex oromandibular reconstruction.

Several composite free flaps have been described for use in oromandibular reconstruction. Particularly in extensive defects, there may be no single flap which combines sufficient bone stock with thin, pliable, soft tissue. By combining two free flaps, the best osseous and soft-tissue elements may be independently selected, to yield a result superior to that achievable with one free flap alone. Thirteen patients underwent reconstruction of extensive oromandibular defects using the free fibula for mandibular reconstruction and the free radial forearm flap for oral lining and soft-tissue reconstruction. Mandibular defects were usually extensive, involving over half of the mandibular contour. Soft-tissue defects were all complex and involved multiple surfaces of the oral, oropharyngeal, and nasopharyngeal mucosa. All patients were operated on in the supine position by two surgical teams (extirpative and reconstructive) working simultaneously. Each free flap was supplied by its own set of recipient vessels. The mean total operating time was 12 hr. Postoperative courses were without mortality or significant morbidity. There were no flap failures. Soft-tissue and osseous reconstructions healed completely. Aesthetic contour was judged good to excellent in 11 patients. Soft and solid diets were achieved in five patients, with six patients on a purée or liquid diet. Oral competence was present in 11 patients. Speech was excellent to good in six patients and fair in four patients. The mean follow-up has averaged 18 months. Three patients have died of recurrent disease, and two of unrelated causes. The remaining eight patients are currently free of disease. In combining the free flaps, the best tissue for bone and soft-tissue reconstruction was selected independently. The two-team approach avoided excessive operating time and operating team fatigue. The added degree of freedom provided by the two free flaps with their independent pedicles made insetting easier, compared to working within the limitations of a single composite flap. For extensive oromandibular defects, the simultaneous free fibula and radial forearm free flaps provided ideal osseous and soft-tissue reconstruction, with acceptable operating times and reasonable functional results.

Adult↗
PubMed1997

Vascularized fibula graft for spinal fusion in severe cervical kyphosis due to neurofibromatosis.

A successful anterior spinal fusion using vascularized fibula graft in the case of a 17-year-old male with severe cervical kyphosis due to neurofibromatosis is reported. Anterior spinal fusion at C2-7 using the fibula graft was performed with spinous process wiring. The kyphosis was corrected from 85 to 38 degrees. Bony fusion was obtained in 5 months without loss of correction.

Adolescent↗
PubMed1988

Dual vascularized fibula transfer on a single vascular pedicle: a useful technique in long bone reconstruction.

The use of dual vascularized fibula transfer on a single vascular pedicle for reconstruction of long bone defect is described. This technique involves dividing one length of donor vascularized fibula into two segments, without cutting the vessels. The vessels are then folded, thereby supplying blood circulation to both bones. Since 1985 the authors have treated six cases of bone reconstruction using this method. Two of these six cases are reported, with follow-up periods of over one year.

Adult↗