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. 2017 Mar;16(1):101-107.
doi: 10.1007/s12663-016-0930-6. Epub 2016 Jun 9.

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Sunil S Shroff  1 , Sanjiv C Nair  1 , Anjan Shah  1 , Balasubramanya Kumar  1
Affiliations

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Sunil S Shroff et al. J Maxillofac Oral Surg. 2017 Mar.

Abstract

Purpose: To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region.

Patients and methods: The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study.

Results: The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %.

Conclusion: The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.

Keywords: Distraction osteogenesis; Donor site morbidity; Double-barrelled; Fibula free flap; Maxilla and mandible; Reconstruction; Retrospective.

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Conflict of interest statement

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
HCL classification of mandibular defects. C central segment, L lateral segment excluding condyle, H lateral segment including condyle
Fig. 2
Fig. 2
Brown’s classification of maxillectomy defects. Class I = without oroantral fistula, class II = low level excluding floor of orbit, class III = high level including orbital contents, class IV = radical maxillectomy including orbital extenteration
Fig. 3
Fig. 3
a C-category, b LC-category mandibular defects
Fig. 4
Fig. 4
a Class II, b class III maxilllectomy defects
Fig. 5
Fig. 5
a Weber Ferguson incision. b Midline lip-split with skin crease extension in neck. c Visor incision
Fig. 6
Fig. 6
Skin paddle used for a intra-oral lining, b corner of mouth
Fig. 7
Fig. 7
Donor site: a without skin paddle, b with skin paddle
Fig. 8
Fig. 8
Number of osteotomies: a one, b two
Fig. 9
Fig. 9
Prebending of reconstruction plate
Fig. 10
Fig. 10
a Single barrel fibula. b Double barrel fibula
Fig. 11
Fig. 11
a, b Distraction osteogenesis of fibula free flap; c, d dental implant placement in distracted fibula free flap
See this image and copyright information in PMC

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