Abstract

BackgroundThe repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The fibular free flap (FFF) is one of the standard treatment choices for reconstruction. The conventional FFF has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation. To improve the use of FFF, we add the flexor hallucis longus (FHL) in the flap (FHL-FFF). In this paper, we described the advantage and indication of FHL-FFF and conducted a retrospective study to compare FHL-FFF and FFF without FHL.MethodsFifty-four patients who underwent FFF were enrolled and divided into two groups: nFHL group (using FFF without FHL, 38 patients) and FHL group (using FHL-FFF, 16 patients). The perioperative clinical data of patients was collected and analyzed.ResultsThe flaps all survived in two groups. We mainly used FHL to fill dead space, and the donor-site morbidity was slight. In FHL group, flap harvesting time was shorter (118.63 ± 11.76 vs 125.74 ± 11.33 min, P = 0.042), the size of flap’s skin paddle was smaller (16.5 (0–96) vs 21.0(10–104) cm2, P = 0.027) than nFHL group. There were no significant differences (P > 0.05) in hospital days, hospitalization expense, rate of perioperative complications, etc. between the two groups. Compared with FFF without FHL, FHL-FFF will neither affect the use of flap nor bring more problems.ConclusionThe FHL-FFF simplifies the flap harvesting operation. The FHL can form good mucosa and make FFF rely less on skin paddle. It can be used for adding flap tissue and dealing with perforator vessel variation in reconstruction of maxillary and mandibular extensive defects.

Highlights

  • The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons

  • The conventional fibular free flap (FFF) is mainly composed of fibula and skin paddle

  • We described the use of flexor hallucis longus (FHL) in FFF and the indication of flexor hallucis longus in FFF (FHL-FFF)

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Summary

Introduction

The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The fibular free flap (FFF) is one of the standard treatment choices for reconstruction. The conventional FFF has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation. The maxillary and mandibular extensive defects are often caused by tumor surgery, trauma, etc. The patients have urgent desires to repair and reconstruct the defects. Fibular free flap (FFF) was firstly described by Taylor in 1975 [1], and Hidalgo [2] firstly introduced it for. The conventional FFF is mainly composed of fibula and skin paddle. We find that only fibula and skin paddle are not enough to repair extensive defect. In follow-up visits, the patients always complain about the skin paddle’s discomfort in the oral cavity

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