Anatomical study and clinical application of fibular osteocutaneous flap —For maxillo-mandibular reconstruction and dental implant installation—

Abstract

Anatomical investigation on the fibular osteocutaneous flap from 60 legs of 30 cadavers, and clinical study of ten patients reconstructed by these flaps were retrospectively discussed, based on results from the anatomical investigation. Conclusions are as follows: 1. Two to eight cutaneous branches, with averaged 3.7±1.1 per leg, are located at the mid-portion of leg. The mean inner diameter of peroneal artery and vein were 2.2±0.6mm and 2.7±1.0mm respectively. The mean of length of vascular pedicle was 3.8±0.9 cm. Fibular bone, which can be harvested, was 21.2±1.8cm. 2. Vertical bone height when minimum length of horizontal section is 6mm in diameter at each four portions per leg, total number of 240 cross-sectional faces of 60 legs were measured. 72 sections of 32 legs (30.0%) were shorter than 10mm, 16 sections of 8 legs (22.2%) in male and 56 sections of 24 legs (77.8%) in female. 3. Ideal mandibular contour could be reformed using osteotomy technique at several portium of fibula. Elongation of vascular pedicle was possible without extensional vein graft when periosteum is conserved. 4. We concluded that fibular osteocutaneous flap is one of the most excellent material and procedure for the reconstruction of the mandible because of flexible designing to cover both soft and hard tissue defects, and also fibular bone itself is strong and enough size to be installed by dental implant.