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. The doublebarrel fibula technique was introduced by jones et al. Microvascular free tissue transfer allows one to transfer. Atlas of mandibular and maxillary reconstruction with the fibula flap. Vascular pedicle ossification of free fibular flap. Reconstruction of a defect interrupting the mandible can use osteosynthesis plates, bone graft or pediculated or free flap. The role of cta in the preoperative workup of free fibular. Pdf fibula free flap splitting for mandible reconstruction. How to harvest free fibula flap for mandibular reconstruction. Of all the flaps currently known, the fibula has become the technique of choice 1, 2.
Apart from the surgeons comfort, the technique reduces operative time and, especially, flap ischemia time. Fibula free flap in mandibular reconstruction request pdf. Your jaw may be rebuilt using bone from another part of your body the donor site. Pdf conformation of the fibula flap to passively adapt to the remaining mandible may be indeed. The bone may be taken from your fibula, which is the smaller of. The fibula free flap is reconstructive surgery that takes bone and blood vessels from the patients leg for the reconstruction of the jaw after the surgical removal of some or all of the jawbone. Mandibular reconstruction continues to be one of the most common surgical challenges faced by oral and maxillofacial surgeons. Five defects consisted of bone alone, and four others had only a small amount of associated intraoral softtissue loss. This fibula free flap fff has recently become a more and more popular.
This peroneal flap can be used as a free or pedicled flap and then can be used as a distally or proximally pedicled flap. The use of a fibular free flap is an outstanding, but delicate, treatment option. It is a vascularised free composite flap containing bone. This handout explains what to expect during your hospital stay after your fibular free flap surgery.
Stepbystep mandibular reconstruction with free fibula flap modelling. Abstractfree fibula flap is the most common free tissue transfer for maxillary and. To learn more about the department of otorhinolaryngology at mayo clinic, visit. 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. The microvascular fibula free flap, popularized by hidalgo, has been one of the. A long segment of bone up to approximately 22 cm is available for harvest. According to us, fibula free flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. All patients who underwent fibula freeflap mandibular reconstruction between 20. Fibula osteocutaneous free flap dissection surgical video. This pdf is available for free download from a site hosted by medknow.
The fvff technique was first developed by taylor et al. The fibula flap has been used extensively for oromandibular reconstruction. Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. Osteocutaneous fibula free flap iowa head and neck protocols. The fibula free flap for postresective reconstruction of the mandible. Computed tomographic angiography perforator localization for. This atlas deals with the standard technique used for reconstructing the. It can be raised with a skin island for compositetissue reconstruction. About your mandibulectomy and fibula free flap reconstruction. Innervation of the flap is possible, and the flap has ample bone stock for the placement.
Stepbystep surgical technique for mandibular reconstruction with. Pdf the fibula free flap in maxillary reconstruction. This article is from acta otorhinolaryngologica italica, volume 33. Please be advised that this video contains graphic footage of surgery. Pdf the maxillectomy defect can be a daunting reconstructive challenge to many oral and maxillofacial surgeons. You may have a mandibulectomy if you have a tumor involving your jaw. Fibula osteocutaneous free flap dissection video youtube. These grafts, using the doublebarrel technique, can achieve an almost complete.
The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. Virtual planning and guided surgery in fibular freeflap mandibular. The fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. Transfer of a free vascularised fibular flap fvff is an option for treating bone defects of 5 cm or more in children. The technique allows for anatomic perforator localization during the. Moreover we can use this flap with the fibula or the soleus muscle.
It includes where you will stay after surgery and who will provide your care. The mucosalized muscle cuff of a boneonly fibula free flap forms a superior. In paediatric patients, the fvff is used chiefly for bone defects due to a tumour, infection, or trauma, although other indications include congenital pseudarthrosis of the tibia and avascular. This report describes 3 patients treated with this novel technique and adds to the 4. Free vascularised fibular flap harvesting in children. Ct angiography may be used preoperatively to evaluate the vascular supply of the lower leg prior to free fibula flap harvest.
Here, we aimed to establish the preplating technique. The skin paddle has proven to be dependable if care is taken to preserve the fasciocutaneous perforators. Fibula osteocutaneous free flap harvest american head. Mandibulectomy and free flap reconstruction a mandibulectomy is a surgery to remove all or part of your jaw mandible.
The present study sought to assess the impact of virtual planning and guided surgery. The utility of ct angiography in diagnosing vascular variations and disease is welldocumented. Fibula free flap in mandibular reconstruction atlas of the oral. Pdf how to harvest free fibula flap for mandibular reconstruction.
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