Fate of Free Fibula Flap Used for Mandibular Reconstruction in Paediatric Population: Effect on Growth, Function, Symmetry—A Systematic Review

Optimizing outcomes in pediatric microvascular mandibular reconstruction: A 23-year institutional experience.

Clinical information regarding the fibula flap gained from digital subtraction angiography useful for flap elevation.

AI-augmented mixed reality for 3D visualization of perforator vessels: A feasibility study in fibular flap surgery.

Describe the evolving institutional experience with Jaw-in-a-Day reconstruction and evaluate the functional, oncologic, and surgical outcomes of an efficient and reproducible model that can be used for both benign and malignant cases. Retrospective case series. Tertiary academic referral center and an affiliated private practice. A retrospective review of Jaw-in-a-Day reconstructions performed between January 2023 and January 2024 was conducted. All patients undergoing fibula or scapula free flap reconstruction with immediate dental implantation and provisional prosthesis were included. Operative times and prosthetic workflows were compared by prosthesis capture method (in situ vs at the head) and team composition (single vs integrated two-surgeon teams). Outcomes measured were operative time, flap and implant survival, perioperative complications, Functional Oral Intake Scale (FOIS) scores, and prosthesis use. 33 patients (median age 66; range 13-83) underwent Jaw-in-a-Day reconstruction, 20 malignant disease cases, and 13 benign or traumatic cases. Fibula free flaps were used in 32 cases and scapula in one. Median operative time was 12h19m. Prosthesis capture in situ trended toward shorter operative and prosthetic times but did not reach significance. The two-surgeon approach significantly reduced operative time by 4h24m (P < .001) and prosthodontic time by 2 hours (P = .01). All flaps survived. Implant survival was 97%, with three failures in 2 patients. At 12 months, 32 patients used definitive prostheses and median FOIS was 7. The Jaw-in-a-Day surgical approach is feasible for benign and malignant reconstruction with high flap and implant survival. Early institutional adoption shows a learning curve, but efficiency improves with process refinements, particularly a two-surgeon workflow.

Head and neck squamous cell carcinoma is widespread and projected to increase in prevalence by approximately 30% by 2030. This study evaluates the association between body mass index (BMI), perioperative frailty, and postoperative outcomes, including hospital length-of-stay and perioperative complications for patients undergoing fibular free-tissue reconstruction for head and neck defects.We conducted a retrospective, multi-institutional cohort study using the American College of Surgeons National Surgical Quality Improvement Program database, encompassing subjects of mandibular malignancy radical excision with free myocutaneous and fibular flap reconstruction between 2012 and 2022. Primary independent variables were BMI and modified frailty index-11 (mFI-11) scores. Descriptive statistics and logistic regression analyses were employed to explore the relationship between BMI, frailty, hospital stay, and perioperative complications.A total of 4,808 patients were included (3,082 males, 1,723 females). Within this cohort, 36.5% were normal BMI (18.5-25.0; n = 1,755), 5.3% were underweight (BMI < 18.5; n = 255), and 58.2% were overweight or obese (BMI > 25.0; n = 2,798). A total of 2,288 (47.6%) were robust (mFI = 0), 1,624 (33.8%) prefrail (mFI = 1), and 896 (18.6%) frail (mFI ≥ 2). Perioperative complication risk was 38.4% for normal-weight patients, 55.3% for underweight patients (p < 0.001), and 28.8% for overweight/obese patients (p < 0.001). Multivariate analysis revealed that overweight/obese patients had shorter hospital stays (β: -1.0 days, 95% [CI]: -1.5 to -0.5, p < 0.001) compared with normal-weight patients. Normal-weight patient complication rates increased from 26.9% (robust) to 39.0% (frail, p = 0.0003). Conversely, robust patient complication rates were lower in overweight (23.2%) and obese (23.1%) compared with underweight (42.4%). The highest-risk group consisted of underweight, frail patients (56.2%).Underweight BMI and physiologic frailty function as independent yet synergistic risk factors for poor outcomes after free myocutaneous or fibular flap reconstruction following radical mandibular tumor excision. Notably, decreased BMI confers a greater risk than frailty. These findings challenge the obesity paradox and mandate assessing both nutritional status and physiologic reserve for optimal risk stratification.

Combining cryopreserved autografts and vascularized bone flap for craniofacial defect reconstruction in fibrous dysplasia: a case report

Difficult airway management in giant mandibular ameloblastoma: a case report of awake fiberoptic-guided retrograde intubation

Fibula flap versus soft tissue flap with reconstruction plate for mandibular stage 3 medication-related osteonecrosis of the jaw: a retrospective cohort study

Algorithmic recipient vessel selection for vessel-depleted lower limbs.

Artificial intelligence outperforms a nomogram for osteoradionecrosis prognostication following fibula free flap reconstruction in oral cancer patients.

Use of stock DICOM data of fibular bone for CAD-CAM design in facial reconstruction by free fibula flap

Donor site selection for bone tissue reconstruction in head and neck surgery has remained a matter of debate since the advent of microsurgical techniques. Both the fibula and the deep circumflex iliac artery (DCIA) free flaps offer specific advantages but also present distinct morbidity profiles that must be considered to provide optimized and personalized reconstructive treatment for each patient. A retrospective morbidity analysis was conducted on 66 osseous free flaps (fibula and DCIA) used for head and neck reconstructive surgery at Ramón y Cajal University Hospital over a 6-year period (2018-2024). Surgical variables, as well as local and systemic complications, were analyzed. Reconstruction with the DCIA free flap was associated with a threefold higher risk of developing systemic infections not related to surgical site (47.37% vs. 21.28%; OR=3.33; 95% CI=1.07-10.41) compared with the fibula free flap. No statistically significant differences were observed between the two groups regarding free flap failure, surgical site infections, postoperative bleeding, microvascular complications, or donor site morbidity. the DCIA free flap may be associated with a higher risk of systemic infections. Therefore, for patients with predisposing factors for systemic infections, the fibula free flap might represent a safer donor site. These findings could help refine donor site selection and improve individualized planning in head and neck reconstructive surgery.

Reconstruction of maxillofacial defect is challenging in maxillofacial surgery. Currently, microvascular anastomosis technique is widely used in reconstruction surgery of maxillofacial defects. The neck recipient vessels are used for conventional microvascular anastomosis. This will produce new incision in neck. To avoid the incision in neck, a new technology of anastomosis is revealed, which using the intraoral approach (ITA). Furthermore, ITA technique can also help when the length of vessel pedicle is short and reduce the injury risk of facial nerve. In this paper, we used intraoral anastomosis technique for anterior maxillofacial reconstruction. The defect was reconstructed with free microvascular fibular flap by anastomosis to the facial vessels by ITA technology. The primary aim of the study was to reveal the reliability and outcomes of ITA for maxillofacial defect reconstruction. Our results reveal that ITA is a reliable technique that could avoid additional external incisions in maxillofacial defects.

Reconstruction of mandibular defects using free fibula flaps with a spliced surgical template system.

Virtual Surgical Method Using 3d Model in Mandibular Reconstruction with Fibular Flap: Original Research

Combined fibula and anterolateral thigh flap for the reconstruction of complex Oro-mandibular defects

Double-Barrel Vascularized Fibula Flaps for Mandibular Reconstruction: Clinical Experience and Difficulty in Achieving Dental Implant Placement

This study aimed to compare longitudinal quality of life (QoL) and surgical outcomes following segmental mandibulectomy and free fibula flap reconstruction among patients with osteoradionecrosis (ORN), malignant disease, and benign conditions. A comparative cohort study was conducted involving 245 patients: 45 with ORN, 160 with malignancy, and 40 with benign disease. Patient-reported QoL was assessed using the EORTC QLQ-C30 and QLQ-H&N35 questionnaires preoperatively and at 3, 6, and 12 months postoperatively. The primary outcomes were 12-month Global Health Status (QLQ-C30) and Pain scores (QLQ-H&N35), analyzed using multivariable linear regression. The secondary outcome was the incidence of major surgical complications (Clavien-Dindo ≥ III), analyzed using multivariable logistic regression. At 12 months, the ORN cohort demonstrated significantly worse QoL outcomes compared to the benign cohort, with a -14.1-point lower Global Health Status (95% CI: -19.5 to -8.7, p<0.001) and a +21.5-point higher Pain score (95% CI: +15.2 to +27.8, p<0.001), after multivariable adjustment. The ORN cohort also had the highest rate of major complications (48.9% vs. 17.5% benign, p<0.001), which remained significant in multivariable analysis (aOR for benign vs. ORN: 0.26, p=0.006). Larger bony defect length and longer operative time were independent predictors of poorer QoL and higher complication risk, while the use of virtual surgical planning was associated with better Global Health Status. Despite successful reconstruction, patients with ORN experience profoundly poorer long-term QoL, persistent pain, and a significantly higher complication burden compared to patients with benign or malignant disease. These findings highlight the unique challenges in ORN management and underscore the need for specialized long-term supportive care.

Midface reconstruction should address both functional and cosmetic aspects. The vascularized fibular osteomyocutaneous flap (VFOF) is a promising first choice because of its numerous advantages in this type of reconstruction.This study aimed to investigate the causes of VFOF failure during midface reconstruction. We retrospectively reviewed patients who underwent midface defect reconstruction using VFOF from August 2011 to May 2022 at a single center. The primary outcome variable was VFOF loss within 30 days, and secondary outcomes included late complications related to VFOF occurring at least 6 months postoperatively.A total of 62 patients underwent VFOF reconstruction for midface defects. The VFOF technique was primarily used in 56 (90.3%) patients for initial reconstruction. according to the Brown and Shaw classification, most reconstructions were performed for Class III (77.4%) and Class b (83.6%) defects. Skin paddles of the VFOF were used in 51 (82.3%) patients, and a double flap technique utilizing the fibular was employed in 24 (38.7%) patients. VFOF failure occurred in 10 (16.1%) patients. Prognostic factors associated with VFOF failure included sex (p = 0.01) and maxillary Brown and Shaw classification (horizontal; p = 0.01). Long-term follow-up of 47 patients revealed late complications in 11 (23.4%) patients, and diabetes mellitus was identified as a significant risk factor (p < 0.01).The VFOF is suitable for midface defect reconstruction; however, proper placement of the fibular bone, avoiding pedicle vessel kinking, ensuring tension-free vascular anastomosis during surgery, considering the use of an additional flap in addition to the fibula flap for large defects, and diligent postoperative nasal care are essential.