OP032: What can fibula flap do in jaw reconstruction?

Abstract

Part A 3-D model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap 3-Dimensional model simulation technique and free fibula osteomyocutaneous flap flow-through from radial forearm flap were used to reconstruct a total maxillectomy defect for a 21-years-old female patient. Preoperatively, the 3-dimensional simulated resin models of skeleton and fibula were used to design. In surgery, a 22-cm length free fibula was divided into four segments to make skeletal framework as surgical planning with a radial forearm flap flow-through for the free fibula flap with the skin paddle to repair the palatal and nasal region. Free fibula and radial forearm flap were alive, and the patient was satisfied with the results both aesthetically and functionally due to dental rehabilitation which was carried out 6 months postoperatively. This preliminarily clinical study and case demonstrated the fibula osteomyocutaneous flap is an ideal donor site in total maxillectomy defect reconstruction; the flow-through forearm radial flap not only serves as the vascular bridge to midface reconstruction, but also provides sufficient soft tissue cover for the intra-oral defect. Part B Double barrel fibula free flap with second-staged dental implants for mandibular reconstruction. The aim of this study was to evaluate the method for segmental mandibular reconstruction using double-barrel fibular flap with second-staged dental implant-supported prosthetic rehabilitation. 5 patients (2 gingival carcinomas, 2 ameloblastomas and 1 keratocyst) had undergone segmental mandibulectomy with 6–9 cm defect length. After tumor resection, double barrel fibula osteomyocutaneous flaps were used to reconstruct the mandible. All the flaps were alive with no complications post-operatively. Follow-up at 6 months showed good osteo-integration in panoramic radiograph and esthetic facial appearance. The patients underwent second-stage implants 8 months after fibula transplantation and implant-supported prosthesis was installed 1–2 months later to complete teeth rehabilitation.