Nonvascularised fibular bone graft after vascular crisis — a compensate on the failure of vascularised fibular

Abstract

Objectives: To discuss the feasibility of preserving nonvascularised fibular bone grafts after the failure of vascularised free fibular flaps and clarify the key points. Methods: Ten patients who had preserved nonvascularised fibular bone grafts after the vascular crisis of vascularised free fibular flaps were included in this study. All of these cases were performed in Peking University School and Hospital of Stomatology from 1 January 2010 to 31 December 2014. Segmental mandible resection was performed due to tumours and trauma, reconstructed with vascularised free fibular flaps simultaneously. After the first operation, vascular circulation could not be obtained again. Nonvascularised fibular bone grafts were kept to restore the function and the facial aesthetics. At this time, the soft tissue, which included muscle, fascia and marrow, should be removed as thoroughly as possible and rigid fixation was done. Then intraoral incision was closed by several layers and water-tight result should be gotten. Proper drainage was put and kept for a few days after operation accompanying with sufficient antibiotics. Findings: Nonvascularised fibular bone grafts were preserved successfully without infection in all 10 cases. Follow-up results proved that all grafts have good combination with the residual mandible. The basic function and facial aesthetic results was kept and the patients were satisfied. Conclusion: Nonvascularised fibular bone grafts can be preserved successfully to restore the segmental bone defect of mandible after the failure of vascularised free fibular flaps. Some special key points should be pay attention to get good result.