Fibular Osteomyocutaneous Flap Research Articles

Poster 032: 3-D Model Simulation and Reconstruction of Composite Total Maxillectomy Defects With Fibula Osteomyocutaneous Flap Flow-Through From Radial Forearm Flap

Summary: A total maxillectomy always causes composite defects of maxilla, zygomatic bone, orbital floor or rim, and palatal and nasal mucosa lining thus leading to significant functional and cosmetic consequences after ablative surgery of malignancies in oral cavity, paranasal sinuses, and other upper aerodigestive tract. 3-dimensional reconstruction of total maxillectomy with sufficient bone support and soft tissue graft lining is a complex and challenging aim of oro-maxillofacial and plastic surgeons.

Clinical study of large mandibular cystic lesions treated by decompression

lower lip up to each commisure as well as the skin of the chin and submental area. A fibula osteomyocutaneous microvascular flap was used to reconstruct the mandible. The fibula’s skin paddle was de-epithelized along its superior perioral margin to allow inset of the BPCLF. An upper double cross-lip flap completed the lower lip reconstruction. Flap division occurred three postoperatively. Planned, postoperative radiation therapy ensued by the fourth-week. Results: Case 1: Postoperatively, the donor and recipient site healed well and no secondary revision was needed. The patient demonstrated normal articulation, lip competence, facial expression, without microstomia. Excellent oral competence and esthetics are noted at 44 months post-op. Case 2: At six-month follow-up, the patient presented with essentially normal perioral function and good cosmertic result. He subsequently died from myocardial infarction at 12 months. Conclusion: The BPCLF, offers what may be an optimal balance between esthetics and function and are applicable to near total lower lip defects that preserve the commissures. Post-operatively, these patients are without significant microstomia, and are capable of inserting mandibular prostheses to optimize nutrition and hygiene.

Reconstruction of mandible defect in osteoradionecrosis patients with free fibula osteomyocutaneous flap

目的 评价游离腓骨(肌)皮瓣重建放射性下颌骨坏死术后缺损的临床效果.方法 以带肌袖和不带肌袖的游离腓骨(肌)瓣重建放射性下颌骨坏死手术切除后的骨缺损,以皮岛修复瘘周软组织缺损,记录腓骨截骨、组织瓣存活情况,供区、受区并发症,术后张口度和余留牙咬合情况,对颌面部外形和功能重建进行评价.结果 随访3～16个月,4例带肌袖腓骨肌皮瓣、5例不带肌袖腓骨皮瓣重建下颌骨缺损均获成功.下颌骨截骨长度6.0～17.0 cm,切取腓骨长度8.6～17.0 cm.腓骨截成三段2例,二段5例,截成二段后折叠2例.无1例发生严重供区或受区并发症.所有病例外形恢复良好,双侧下颌角处于同一平面,无中线偏斜,开口度2.5～3.3 cm,余留牙咬合正常.义齿修复后咀嚼功能满意.结论 游离腓骨(肌)皮瓣存活率高,外形和功能恢复好,适合于放射性下颌骨坏死术后颌面部软硬组织缺损的即刻重建。

One-stage reconstruction of bilateral mandibular with free fibula flap

To explore the method of clinical application and the efficacy of free fibula osteomyocutaneous flap in one-stage reconstruction of transmidline bilateral mandibular defect caused by giant neoplasms. From july 2000 to october 2002, transmidline bilateral mandibular defects caused by ameloblastoma (4 cases) and gingival carcinoma (2 cases), according to the character of defects, were reconstructed with free fibula osteomyocutaneous flaps. Peroneal artery and vein were used as vascular pedicle, the fibula was reshaped, and micro-titanium plates were used in rigid fixation between fibula and residue of bilateral mandible. Microvascular anastomoses were carried out between peroneal artery/vein and small artery/vein in neck. Six free fibular osteomyocutaneous flaps survived well. Follow up duration ranged from 6 months to 2 years, the lower face appearance recovered well, occlusion relationship were normal, all patients were satisfactory with appearance and chewing function after repair of removable denture. Free fibular osteomyocutaneous flap is a favorable material in the reconstruction of transmidline bilateral mandibular giant defect. The blood supplement of fibula is offered both by segmentral periosteum and nutrient artery from bone marrow, It is greatly benefit to reshaping as arched mandible.

Applied anatomy of the V-shaped fibular osteomyocutaneous flap in reconstruction of the hindfoot.

To establish the applied anatomy of the V-shaped fibular osteomyocutaneous flap pedicled on the peroneal vessels, cadaver dissections were made in 60 lower limbs and 40 calcanei were examined to sum up the features of calcaneal biomechanics on the stability of the foot and the blood supply of the fibular osteomyocutaneous flap. There were four anastomoses and large communicating branches between the lower segment of the peroneal artery and the anterior and posterior tibial arteries. The flap was well supplied by a retrograde circulation through these anastomoses. A suitable length of pedicle was 20 cm. In the sagittal section of the calcaneus passing through the center of the articular surface for the cuboid bone, the arrangement of the trabeculae formed a triangular zone. The V-shaped flap corresponds nicely with the calculated lines of stress evoked by the weight of the body. The procedure may provide a new method for hindfoot reconstruction. This flap meets the criteria outlined for composite tissue reconstruction of defects of the extremities and biomechanics of the hindfoot, especially for calcaneal and cuboid defects.

Fibula osteomyocutaneous flap combined with dental implants in mandibular reconstruction

Fibula osteomyocutaneous flap combined with dental implants in mandibular reconstruction