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. 2016 Dec;36(6):469-478.
doi: 10.14639/0392-100X-1282.

Fibular osteofasciocutaneous flap in computer-assisted mandibular reconstruction: technical aspects in oral malignancies

M Berrone  1 , E Crosetti  2 , P L Tos  3 , M Pentenero  4 , G Succo  5
Affiliations

Fibular osteofasciocutaneous flap in computer-assisted mandibular reconstruction: technical aspects in oral malignancies

M Berrone et al. Acta Otorhinolaryngol Ital. 2016 Dec.

Abstract
in English, Italian

Virtual surgical planning technology in head and neck surgery is witnessing strong growth. In the literature, the validity of the method from the point of view of accuracy and clinical utility has been widely documented, especially for bone modelling. To date, however, with its increased use in head and neck oncology, and consequently the increased need for bone and soft tissue reconstruction, is important to carry out the virtual programme considering not only bone reconstruction but also all aspects related to the reconstruction of soft tissue using composite flaps. We describe our approach to virtual planning in the case of composite flaps. The study reports six consecutive patients with malignant disease requiring mandibular bone and soft tissue reconstruction using fibular osteocutaneous flaps. In all six patients, the resection and reconstruction were planned virtually focusing on the position of cutaneous perforator vessels in order to schedule fibula cutting guides. There were no complications in all six cases. The technique described allowed us to schedule composite fibula flaps in mandibular reconstruction virtually with good accuracy of the position of the bone segment in relation to the cutaneous paddle, important for soft tissue reconstruction. Despite the limited number of cases, the preliminary results of the study suggest that this protocol is useful in virtual programmes using composite flaps in mandibular reconstruction. Further investigations are needed.

L’utilizzo della pianificazione virtuale in chirurgia testa e collo è in forte crescita. In letteratura, la validità del metodo dal punto di vista dell’acuratezza e l’utilità clinica sono stati ampiamente documentati, in modo particolare per il rimodellamento osseo del lembo. Al giorno d’oggi, l’aumentato utilizzo della programmazione virtuale in chirurgia oncologica testa-collo e, conseguentemente, la maggiore necessità di ricostruzioni sia ossee che dei tessuti molli, rendono importante realizzare il programma virtuale considerando non solo la ricostruzione ossea, ma anche tutti gli aspetti relativi alla ricostruzione dei tessuti molli con lembi compositi. Descriviamo nel seguente articolo il nostro approccio alla pianificazione virtuale nel caso di lembi compositi. Lo studio riporta sei pazienti consecutivi con malattia maligna programmati mediante ricostruzione mandibolare computer assistita e lembi osteo-fascio-cutanei di perone. In tutti i sei pazienti, la resezione e la ricostruzione sono state progettate concentrandosi sulla posizione dei vasi perforanti cutanei, al fine di programmare la posizione più corretta delle guide di taglio a livello del perone in funzione della posizione dei vasi perforanti stessi. La tecnica descritta ci ha permesso di programmare lembi osteo-fascio-cutanei di perone nella ricostruzione mandibolare computer assistita, con buona precisione della posizione del segmento osseo rispetto alla padella cutanea, importante per la ricostruzione dei tessuti molli. Nonostante il numero limitato di casi, i risultati preliminari dello studio suggeriscono che questo protocollo è utile nella programmazione virtuale. Sono necessarie ulteriori indagini.

Keywords: Computer-assisted mandibular reconstruction; Fibula harvestin; Fibular osteofasciocutaneous flap; Mandibular reconstruction; Virtual surgical planning.

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Figures

Fig. 1.
Fig. 1.
a) Preoperative measurements of the distance between the malleolus and the perforator vessel; b) Preliminary measurements of the resective and reconstructive programme from CT scan; c) Reproduction of the distance between the malleolus and the perforator vessel on the virtual programme for fibula harvesting; d) Mandibular cutting guides.
Fig. 2.
Fig. 2.
a) Mandibular and fibular cutting guides were provided with fixation holes for temporary fixation and trocar guides for PSP fixation screws; b) Mandibular osteotomies completed with soft tissue resection; c) Preoperative measurements of virtual surgical planning and of the distance between the malleolus and the perforator vessel are drawn on the leg skin; d) Virtual surgical planning measurements.
Fig. 3.
Fig. 3.
a) Check of fibula cutting guides; b) Modification of the fibula cutting guides; c) Modified guide not interfering with perforator vessels; d) Fibula modelled before detaching the vascular pedicle.
Fig. 4.
Fig. 4.
a) Shaped fibula secured to the PSP in the planned position; b) Fibula and plate fixed to the native mandible; c) Extremely precise bone-to-bone contact and positioning; d) Extremely precise bone-to-bone contact.
Fig. 5.
Fig. 5.
a) Pleasant aesthetic final result; b) Good intraoral anatomy and morphology.
See this image and copyright information in PMC

References

    1. Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84:71–79. - PubMed
    1. Rana M, Warraich R, Kokemüller H, et al. Reconstruction of mandibular defects – clinical retrospective research over a 10-year period. Head Neck Oncol. 2011;28:23–23. - PMC - PubMed
    1. Urken ML, Buchbinder D, Costantino PD, et al. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg. 1998;124:46–55. - PubMed
    1. López-Arcas JM, Arias J, Del Castillo JL, et al. The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg. 2010;68:2377–2384. - PubMed
    1. Wolff KD, Ervens J, Herzog K, et al. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Craniomaxillofac Surg. 1996;24:330–338. - PubMed