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

Abstract

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. 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 3months post-operatively, were included in this study. The study sample composed of 30 patients with average age of 39.5years. 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 7days. 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%. The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.