Field Of Maxillofacial Surgery Research Articles

Biomechanical evaluation of a custom-made mandibular plate

In the field of maxillofacial surgery, mandibular reconstruction with plates is one of the operations that is performed when resection of part of the jaw is unavoidable in patients suffering from pathologies such as, for example, neoplasms and osteonecrosis. Through the use of standard prostheses, which are commercially available in various models, mandibular reconstruction is possible. However, in the presence of particularly serious and complex clinical pictures, in which it is necessary to resect large parts of the mandibular bone, such as in some oncological cases, the use of serial prostheses is not always resolving. In these cases, a customized implant, designed specifically for the patient, is preferable.Aim of this work is the mechanical evaluation of a custom-made mandibular plate with an innovative bone-implant interface geometry through a finite element analysis. Three physiological loading conditions were analysed: RUC (right unilateral canine) bite, RGF (right group functional) bite and maximum opening. Finally, the maximum pull-out force acting on the fixation screws was evaluated through an experimental fatigue test.

The Role of Large Language Models (LLMs) in Providing Triage for Maxillofacial Trauma Cases: A Preliminary Study.

In the evolving field of maxillofacial surgery, integrating advanced technologies like Large Language Models (LLMs) into medical practices, especially for trauma triage, presents a promising yet largely unexplored potential. This study aimed to evaluate the feasibility of using LLMs for triaging complex maxillofacial trauma cases by comparing their performance against the expertise of a tertiary referral center. Utilizing a comprehensive review of patient records in a tertiary referral center over a year-long period, standardized prompts detailing patient demographics, injury characteristics, and medical histories were created. These prompts were used to assess the triage suggestions of ChatGPT 4.0 and Google GEMINI against the center's recommendations, supplemented by evaluating the AI's performance using the QAMAI and AIPI questionnaires. The results in 10 cases of major maxillofacial trauma indicated moderate agreement rates between LLM recommendations and the referral center, with some variances in the suggestion of appropriate examinations (70% ChatGPT and 50% GEMINI) and treatment plans (60% ChatGPT and 45% GEMINI). Notably, the study found no statistically significant differences in several areas of the questionnaires, except in the diagnosis accuracy (GEMINI: 3.30, ChatGPT: 2.30; p = 0.032) and relevance of the recommendations (GEMINI: 2.90, ChatGPT: 3.50; p = 0.021). A Spearman correlation analysis highlighted significant correlations within the two questionnaires, specifically between the QAMAI total score and AIPI treatment scores (rho = 0.767, p = 0.010). This exploratory investigation underscores the potential of LLMs in enhancing clinical decision making for maxillofacial trauma cases, indicating a need for further research to refine their application in healthcare settings.

Adjunctive Effect of Photobiomodulation Therapy with Nd:YAG Laser in the Treatment of Inferior Alveolar Nerve Paresthesia.

Background: Disruption of peripheral branches of the trigeminal nerve in the field of maxillofacial surgery is a known risk due to the close connection of these branches with the bony structures of the maxilla and mandible. As a result, injuries of the lingual nerve and inferior alveolar nerve take place within routine maxillofacial surgery procedures, including local anesthetic injection, wisdom tooth surgery, and dental implant placement, resulting in paresthesia and dysesthesia. During the last three decades, low-level lasers (LLL) have been frequently used in various medical fields. Lately, this application has increased in several sectors. Methods and materials: This experiment was designed to explore the effect of low-level laser therapy (LLLT) with Nd:YAG on the paresthesia and dysesthesia of the lower lip. This ethics committee of Tbzmed, Tabriz, Iran, proved the present experiment with ethical code: IR.TBZMED.REC.1401.839. Results: After completing 10 sessions of laser therapy for the case group consisting of 25 patients with lower lip anesthesia, the visual analog scale index results revealed that following six sessions of laser therapy, a significant difference appeared in contrast to the control group. Also, according to the two-point tests, significant difference among the experimental and the control group appeared after ninth session of the laser therapy. Conclusions: Altogether, these data suggested LLLT with Nd:YAG as an effective treatment option for decreasing the anesthesia of the lower lip.

Use of Fine Needle Aspiration Biopsy in Diagnosis Oral and Maxillo-Facial Tumors

The Technique of fine needle aspiration biopsy (F.N.A.B.) was evaluated in the field of maxillofacial surgery. For this purpose comparison of cyt ological results with the conventional histo pathological results were take place. Seventy-two specimens were obtained by F.N.A.B. from 60 patients with age range from 3-84 years of both sexes, 11.7% of the patients had previous history of diagnosed malignant tumors. Cytological results show 40 cases(55.5%) were benign tumor, 27 cases (37.5 %) were malignant, 3 cases (4.2 %) unsatisfactory for diagnosis and 2 cases (2.8 %) were suspicious to be malignant. The statistical analysis showed that F.N.A.B. had sensitivity (92.6%), specificity (100%), positive predictive value (92.3%), and accuracy rate (96%).

Features of medical care provision in the profile «Maxillofacial surgery» in the Southern Federal District of the Russian Federation

To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery» in the Southern Federal District of the Russian Federation in order to develop proposals for its optimization within the framework of a three-level system of medical care. We analyzed accounting and reporting materials characterizing the organization of medical care in the field of «Oral and maxillofacial surgery» to the population in the Southern Federal District of the Russian Federation. The population of the Southern Federal District of the Russian Federation is currently provided with accessible round-the-clock medical care in the field of maxillofacial surgery. The forces and means at the disposal of the district government allow this to be implemented. However, the article describes a number of obstacles to the provision of high-quality medical care in the field of maxillofacial surgery and suggests ways to eliminate them. Preparation of an Order defining the functioning of a three-level system of medical care for adults and children with maxillofacial pathology in the Southern Federal District of the Russian Federation, as well as more effective use of telemedicine consultations will significantly improve the availability and quality of medical care.

“3D surface scanner in Maxillofacial Surgery: State of the art.”

Physicians are used to having complementary studies that help us in all phases of our work. In the maxillofacial surgery field the most commonly used tests are radiological tests (CT and NMR) and digital clinical photographs.In recent years, the concept of 3D surgery has been developed and consists of the use of 3D technology applied to surgery. 3D surgery allows us to move from on-site planning of the surgery to pre-surgical planning, with a simulation and preview of the result at the bone and soft tissue level.Radiological studies are of very limited use in soft tissue planning and digital photography is two-dimensional and dependent on patient positioning. The use of the surface scanner solves these limitations as it computes the spatial coordinates of the patient's anatomical surface in order to create a 3D digital model.

Panfacial fractures management, a report of surgical treatment sequence in three cases: A case series study

Multiple facial fractures, which involve the upper, middle, and lower thirds of the face, are called Panfacial fractures, and their management is one of the biggest challenges in the field of maxillofacial surgery. The proximity of maxillofacial skeleton to important sensory or vital structures such as the visual, olfactory, masticatory and respiratory systems and intracranial components in addition to negative effects on esthetic aspects of the face have doubled the intricacy. Small or thin fractured segments that are difficult to find and stabilize make management of pan facial fractures different from anywhere else in the body.
 One major challenge is to find the best pattern and sequence of treatment. There are different concepts, depending on the surgeon's experience and the pattern of fracture. This study reports three patients with the diagnosis of pan facial fractures. A 54-year-old woman, an 18-year-old and a 14-year-old man that were all victims of road traffic injuries (MVA). Conventional open reduction and internal fixation methods have been used and favorable results have been obtained in follow-up periods.

THE WORK’S FEATURES OF MAXILLO-FACIAL SURGEONS OF KYIV AND REGION DURING THE MARTIAL LAW

Background. Maxillofacial surgery, which took place in Ukraine as a separate legally recognized specialty, daily acquires its relevance. Treatment of inflammatory, oncological diseases, congenital malformations, defects and deformities of the face touches the person's face, which has not only medical and aesthetic, but also social significance in society. The question arises of the readiness of the personnel reserve for such a load and modern challenges.
 Aim: to analyze the peculiarities of the work of maxillofacial surgeons in Kyiv and the Kyiv region during wartime, and to identify the main problems they face in their work in connection with the existing realities and to determine ways to overcome them based on the data of an anonymous questionnaire.We have developed a questionnaire on the GoogleForm platform, concerning training and advanced training of specialists, theoretical and practical aspects of the treatment of gunshot and mine-explosive trauma, as well as receiving volunteer assistance to clinical hospitals. The study involved 39 doctors of the maxillofacial profile У дослідженні прийняли участь 39 maxillo-facial surgeons and trainee from Kyiv city and Kyiv region.
 Materials and methods. It was determined that doctors watched webinars (69,2%) or read specialized literature on the treatment of gunshot trauma (56,4%). for up-to-date professional information. Most (23.1%) of respondents experience a lack of qualifications when performing secondary reconstructive interventions and rehabilitation of patients with mine-explosive/gunshot. At the same time, 61.5% of doctors conducted online consultations with foreign colleagues, 48.7% - ensured the visit of foreign colleagues to their department.
 Conclusion. Definitely important point is the preparation of qualified human resources in the field of maxillo-facial surgery, a special condition for development is the communication of domestic specialists with international professional community.

N.M. Aleksandrov, maxillofacial surgeon, professor, major-general of medical service (to the 100th anniversary of his birth)

The aim of the investigation is to reveal scientific, clinical, pedagogical and social activity of the eminent maxillofacial surgeon Doctor of medical sciences, professor, major-general of the medical service N.M. Alexandrov and his merits in the sphere of the military dentistry.
 Material and methods. On the basis of analysis of the national literature, as well as life and professional activity and scientific labors of general, major-general of medical service N.M. Alexandrov to present his role in military dentistry development and maxillofacial surgery in Russia.
 Results. The analysis of the information about N. M. Alexandrov showed that he was one of pioneers in developing and implementing in the USSR the endotracheal anesthesia in surgical interventions on the organs and tissues of face and neck, the author of some methods of reconstructive surgeries: upper jaw resection with primary plasty; otoplasty with using the Philatov stalk and local tissue; lower lip plasty using two symmetrical upper lip flaps and others. Methods of treatment of purulent diseases of maxillofacial region and neck with the use of hyperbaric oxygenation, laser therapy and low-frequency ultrasound, laser therapy of temporomandibular joint diseases, as well as cryosurgery of new growths of face and mouth organs, a number of methods of microsurgery and electric anesthesia in dentistry, hemostatic drug "Kaprofer" were developed under his scientific guidance and introduced into the clinical practice.
 Conclusions. N.M. Alexandrov was an excellent clinician, a brilliant teacher and surgeon, a prominent scientist and organizer of military health care; his colleagues and pupils remember him today and honour his merits in the field of maxillofacial surgery and military health care.

A review on 3D printing maxillofacial surgery: Present work and future prospects

The medical field is only one area that stands to benefit from the rapidly expanding capabilities of 3D printing. In the past several years, advances in technology have allowed oral and maxillofacial surgeons to provide better care for their patients. This article provides a brief summary of the present state of 3D printing in oral and maxillofacial surgery. Patient-specific implants created using computer-assisted design aid in the superior imitation of the original anatomical form. The purpose of this paper is to highlight the present applications of 3D printing in the field of maxillofacial surgery for the treatment of face deformities, aesthetic issues and jaw diseases. The medical and dental fields have seen a surge in interest in the use of additive manufacturing. Their growing use on patients has been attributed to better quality and cost effectiveness. This review simply summarized the numerous methods utilised in Bio printing, as well as their varied benefits and drawbacks. While the results of the preliminary studies have been encouraging, additional study is needed before this technology can be practical and affordable. As this technology is adopted more broadly, many more technological and regulatory hurdles will need to be cleared.

The notch of the mandible: what do different fields call it?

The bony notch on the inferior border of the mandible, anterior to the attachment of the masseter muscle, where the facial vessels commonly pass, has been called different names in the literature, e.g., premasseteric notch, antegonial notch, and notch for the facial vessels. Interestingly, various disciplines have leaned toward different names for this notch. Therefore, to aid in consistent communication among professionals, the present study aimed to analyze usage of these varied terms and make recommendations for the best terminology. Based on the adjacent anatomical structures used to name this notch, three groups were analyzed in this study, a group using masseter in the term, a group using gonion in the term, and a group using facial vessels in the term. A literature search found that the group using gonion in the term was found most in the literature. The orthodontics field used gonion in the term the most (29.0%: 31/107) followed by the oral and maxillofacial surgery field (14.0%: 15/107), the plastic surgery field (4.7%: 5/107), and the anatomy field (3.7%: 4/107). The dental field used gonion in this term the most (43.9%: 47/107) and the medical field used facial vessels in the term the most (33.3%: 6/18). Based on these results, the use of gonial terms for this notch seems to be preferred.

Journal of Craniofacial Surgery Open: Welcome to the New Era of Education and Research in the Field of Maxillofacial Surgery

Journal of Craniofacial Surgery Open: Welcome to the New Era of Education and Research in the Field of Maxillofacial Surgery

Vladimir Mikhailovich Uvarov, distinguished Russian dentist and maxillofacial surgeon, professor and colonel of medical service

On the memory page among the Russian dentists and maxillofacial surgeons, it is impossible not to remember the outstanding figure in the worlds military medicine and practical health care, doctor of medical sciences, professor, and colonel of the medical service Vladimir Mikhailovich Uvarov. The study aimed to present scientific, clinical, pedagogical, and social activity of the outstanding dentist and maxillofacial surgeon, doctor of medicine, professor, and colonel of the medical service Vladimir Mikhailovich Uvarov, including his merits in military medicine. On the basis of the analysis of the Russian literature as well as the life, professional activity, and scientific works of Prof. V.M. Uvarov, doctor of medical sciences and colonel of medical service, we present his role in the formation and development of dentistry, maxillofacial surgery, and military medicine in Russia. There is no section of stomatology that V.M. Uvarov would not have paid attention to. He successfully defended 28 dissertations for the degree of candidate of science under his supervision. He is the author of more than 150 scientific works, including six monographs, a textbook, chapters in manuals, and textbooks. He was the author of the chapter on anesthesia and local anesthesia, written for the first textbook in the country Surgical Dentistry (1938). He was an honorable member of the all-union and all-Russian scientific society of dentists of the country; was a great pedagogue; generously shared his scientific, medical, and pedagogical experience with students, cadets, listeners, and lecturers; and carried out great therapeutic and consultative work. His name is among the outstanding maxillofacial surgeons of the country. He proposed the use of an extra-oral apparatus for the fixation of mandibular fractures and other innovations in the field of maxillofacial surgery and dentistry. At present, the students and followers of Vladimir Mikhailovich Uvarov keep him in their memory as a prominent organizer of military and civil health care, a clinician, a scientist, a teacher, and a model of man and humanity. He is remembered and loved.

The use of 3D technologies in the planning of orthognathic operations in patients with anomalies in the development of the jaws

Aim. Improving the methods of planning and the surgical stage of the combined treatment of patients with jaw anomalies using 3D technologies and subsequent assessment of the accuracy of the result.Materials and methods. In the period from 2019 to 2021, 90 patients with anomalies in the development of the jaws aged 18 to 45 years were examined and treated. 45 female patients, 45 male. All patients underwent a comprehensive examination and subsequent surgical treatment. Patients were divided into 3 groups depending on the planning method.Results. When evaluating the results of the study, significant differences were found between the control group (I) and group II and the control group (I) and group III with a difference effect from medium, moderate to large, strong in 25 coordinates out of 35 (71%). There was no statistically significant difference between groups II and III. The average difference in coordinates between planned movements and postoperative results in comparison between groups I and II, groups I and III is from 0.69 mm. up to 2.14 mm. The average difference in coordinates between groups 2 and 3 is from 0.20 mm. up to 0.54 mm. The maximum differences between the planned and postoperative results were revealed in the coordinates responsible for vertical movements, as well as various angles (pitch, roll and yaw), the average deviation for all three groups was in the range from 2.02 mm to 3.13 mm. This fact led to the conclusion that 3D planning allows to achieve more predictable results in the surgical stage of the complex treatment of patients with jaw anomalies. However, for a more accurate assessment of the quality of planning, a larger sample size of patients is needed, with the possible inclusion of a larger number of reference points.Conclusions. The widespread digitalization of the medical industry has made it possible to introduce many tools aimed at increasing the accuracy of preoperative planning, as well as visualizing future changes in the patient. Three-dimensional (3D) methods of virtual visualization and planning allow you to combine information from the soft tissues of the face, skeleton and dentition. Computer simulation of operations is becoming increasingly important in the field of maxillofacial surgery, as the technology offers improved possibilities for preoperative planning and reduction of possible risk factors at the preoperative, operative and postoperative stages.

A Mini-Pig Mandibular Defect Model for Evaluation of Craniomaxillofacial Bone Regeneration.

Craniomaxillofacial bone defects represent a clinical challenge in the fields of maxillofacial surgery and (implant) dentistry. Regeneration of these bone defects requires the application of bone graft materials that facilitate new bone formation in a safe, reliable, and predictive manner. In addition to autologous bone graft, several types of (synthetic) bone substitute materials have become clinically available, and still major efforts are focused on improving such bone substitute materials by optimizing their properties. Given the regulatory necessity to evaluate the performance of new bone substitute materials for craniomaxillofacial bone regeneration in a large animal model with similarity to human bone before clinical application, we here describe a mini-pig mandibular bone defect model that allows for the creation of multiple (critical-size) bone defects within the mandibular body of a single animal. As examples of bone substitute materials, we utilize both the clinically used BioOss granules and an experimental calcium phosphate cement for filling the created defects. Regarding the latter, its advantages are the injectable application within the defect site, in which the material rapidly sets, and the tailorable degradation properties via the inclusion of hydrolytically degrading polymeric particles. For both bone substitute materials, we show the suitability of the bone defect model to assess bone regeneration via histology and micro-computed tomography. Impact statement Given the regulatory necessity to evaluate the performance of new bone substitute materials for craniomaxillofacial bone regeneration in a large animal model with similarity to the human bone before clinical application, we here describe a mini-pig mandibular bone defect model that allows for the creation of multiple (critical-size) bone defects within the mandibular body of a single animal that can be used for the evaluation of the bone regenerative capacity of new bone grafting materials as well as tissue-engineered products for alveolar bone regeneration.

The experience of interdisciplinary interaction in elimination of midface deformation (clinical observation)

Fibrous dysplasia is a hamartoma appearing as a benign pathologic process in which normal bone tissue formation is replaced by overgrowth of fibrous connective tissue. The problem of diagnosis and treatment of patients with fibrous dysplasia remains unsolved in the absence of a uniform understanding of its etiology and pathogenesis. Treatment and rehabilitation of patients with midface fibrous dysplasia is a complicated medico-social problem, which requires interaction of specialists of different fields to resolve it. The disease presents a practical interest for doctors of more than 20 specialties, as it can lead to disability. The present article describes a clinical case of interdisciplinary interaction of specialists in the fields of maxillofacial surgery, ophthalmology, otorhinolaryngology, plastic surgery and radiology involved in complex treatment of a patient with midface fibrous dysplasia accompanied by eyeball dislocation, decreased vision, as well as progressive impairment of nasal breathing function. The performed treatment resulted in favorable functional and aesthetic outcomes including elimination of exophthalmos, vertical strabismus, lacrimation disorders, nasal breathing disorders, increase of visual acuity and improvement of external appearance.

MAJOR ADVANCES IN MAXILLO FACIAL SURGERY AND THE DEVELOPMENT TRENDS

This special edition, titled “Major Advances in Oral and Maxillofacial Surgery And The Developments Trends”, aims to present the main achievements in this field. The use of new scientific and technological achievements has revolutionized the field of maxillofacial surgery, and current trends are aimed at improving evidence-based diagnostic and surgical methods, as well as the quality of patient care. The progress of reconstructive surgery in PCLH was largely facilitated by the improvement of the work of the anesthesiology and resuscitation service, transplantation of tissue grafts and vascularized flaps (both pedunculated and free), new bone substitutes, platelet-rich plasma, tissue genetic engineering, directed tissue osteogenesis, distraction osteogenesis, microsurgery, laser surgery, arthroscopic and endoscopic surgery, radioisotope diagnostics, electron microscopy, endoprosthesis, 3D computer modeling and the use of 3D printers. Modern computer technologies are widely implemented in the field of PCL surgery using visualization methods and the use of navigation, threedimensional images, stereolithographic models, non-standard implants such as magnetic resonance imaging (MRI), computed tomography (CT), surgical navigation. and robotic surgery. The use of guided surgery allows the procedure to be performed faster, safer and more accurately, reducing surgical risks and time. Since the advent of endoscopic surgery, it has been successfully used in the treatment and diagnosis of lesions of the maxillary sinus. Temporomandibular joint arthroscopy is now routinely performed and is a more effective and minimally invasive treatment for TMJ disease. The use of new technologies has also played an important role in the diagnosis and treatment of oncological diseases of the maxillofacial region. Positron emission tomography/computed tomography (PET/CT) is used to diagnose many types of cancer in the area of the PCL and to detect metastases in the lymph nodes. Maxillofacial surgery techniques are constantly evolving and improving, and we hope that our publication will keep pace with these changes.

An overview on the art of piezosurgery in the maxillofacial practice

Introduction: Piezosurgery is an emerging boom in the field of maxillofacial surgery for precise, safe and effective osteotomies sparing the adjacent vital structures compared to conventional surgery. Corpus: It works on the principle of piezoelectric effect in which crystals in the piezoelectric substances get deformed on the application of an electric field. Various studies gave the evidence of improved wound healing and bone formation compared to conventional approaches. The soft tissue sparing capability with improved patient comfort and decreased blood loss gave the utmost importance for this surgical technique in the present as well as future world of surgery. Conclusion: Piezosurgery has emerging as a promising surgical modality with a wide range of clinical applications throughout the whole field of surgery.

Is Artificial Intelligence Transforming Dentistry Today?

Since the birth of science, the most fascinating structure of the human body is the human brain. Over the past centuries’ researchers have been developing the latest technologies to imitate and explore how the human brain functions. However, to develop a machine that thinks like a human brain is still a dream for researchers. Aristotle’s early efforts to devise logical thinking via his syllogisms (a three-part deductive reasoning) were a source of inspiration for modern computers and technologies1. In the1950, Alan Turing designed a machine to decode encrypted messages, which was a breakthrough of super computers in the days of yore. He designed the “Turing Test” which was coined to assess whether a computer could exhibit intelligence better known as “artificial intelligence” (AI) today2. AI is “a field of science and engineering concerned with the computational understanding of what is commonly called intelligent behavior, and with the creation of artifacts that exhibit such behaviour”3.
 Since 1980, AI has come a long way, virtual reality is being used in dental education these days to create real life situations and promote clinical work on simulators to eliminate risk factors associated with training on live patients. Recently artificial intelligence has been integrated with tutoring systems like “Unified Medical Language System” (UMLS), which have resulted in a better quality of feedback, which the preclinical virtual patients provide to the students4,5. This interactive phase helps students to evaluate their clinical skills and compare their skills with the standard ones, thus creating an ideal and high-quality training environment. Studies have been carried out regarding the efficacy of AI systems, which have stipulated that preclinical students build higher competencies than with the use of traditional simulator units6-8.
 Currently AI inbuilt virtual dental assistants are present in the market. They can execute various chair side tasks with greater accuracy and less manpower ensuring minimum error during the procedures. In the world of implantology and maxillofacial surgery AI helps plan and prepare surgeries with smallest details forgoing actual surgery. Some exceptional uses of AI include robotic surgeries in the field of maxillofacial surgery and bioprinting (where tissues and organs can be reconstructed in thin layers)9. The field of AI has flourished to great extent in the past decade; AI systems are an aid to the field of dentistry and dental education. 
 This narrative attempts to explain possible AI-based applications in the future, it can be used for dental diagnosis, planning out treatments, conducting image analysis, and record keeping. AI-based technologies streamline and reduce laborious workforce to routine tasks, it ensures dental procedures are possible at a lower cost and ultimately makes predictive, preventive, and participatory dentistry possible. The use of AI in dental procedures needs to be guaranteed; its application with human oversight and evidence-based dentistry shall be expected. Dental education needs to be introduced to clinical AI solutions by promoting digital literacy in the future dental liveware.

One-stage reconstruction of bone defects with fibula perforator flap

At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.