Free Fibula Osteocutaneous Flap Research Articles

Lip prosthesis as a palliative care modality for a head and neck cancer patient—A case report

The present case report describes the prosthetic management following partial loss of free-fibular osteocutaneous flap in an irradiated patient diagnosed with recurrent head and neck cancer. The patient presented with constant drooling of oral fluids due to an anatomically deficient lower lip. Salvage reconstructive surgery was not considered feasible due to past history of recurrence, multiple surgeries and radiotherapy, and financial constraints. An adhesive-retained interim silicone prosthesis was fabricated to alleviate the functional and psychosocial morbidity. The prosthesis served to restore the oro-facial seal to prevent constant drooling of oral fluids. It also aided in providing an excellent aesthetic solution to palliate the psychological suffering experienced by the patient due to lost facial contours.

Socioeconomic Disparities in Postoperative Outcomes of Osteocutaneous Fibula Free Flaps for Head and Neck Reconstruction.

Osteocutaneous fibula free flaps (FFFs) are a fundamental component of reconstructive surgery in the head and neck region, particularly after traumatic injuries or oncologic resections. Despite their utility, FFFs are associated with various postoperative complications, such as infection, flap failure, and donor site morbidity, impacting up to 54% of cases. This study aimed to investigate the influence of socioeconomic variables, with a particular focus on median household income (MHI), on the incidence of postoperative complications in FFF reconstruction for head and neck cancer. A retrospective analysis of 80 patients who underwent FFF reconstruction for head and neck cancer at a single center from 2016 to 2022 was conducted. Demographic and patient characteristics, including race, MHI, insurance type, history of radiation therapy, and TNM (tumor, node, metastasis) cancer stage, were evaluated. Logistic regression, controlling for comorbidities, was used to assess the impact of MHI on 30-, 90-, and 180-day postoperative complications. The patient population was predominantly male (n = 51, 63.8%) and White (n = 63, 78.8%), with the majority falling within the $55,000 to $100,000 range of MHI (n = 51, 63.8%). Nearly half of the patients had received neoadjuvant radiation treatment (n = 39, 48.75%), and 36.25% (n = 29) presented with osteoradionecrosis. Logistic regression analysis revealed that the $55,000-$100,000 MHI group had significantly lower odds of developing complications in the 0- to 30-day postoperative period when compared with those in the <$55,000 group (odds ratio [OR], 0.440; 95% confidence interval [CI], 0.205-0.943; P = 0.035). This trend persisted in the 31- to 90-day period (OR, 0.136; 95% CI, 0.050-0.368; P < 0.001) and was also observed in the likelihood of flap takeback. In addition, the $100,000-$150,000 group had significantly lower odds of developing complications in the 31- to 90-day period (OR, 0.182; 95% CI, 0.035-0.940; P = 0.042). No significant difference was found in the >$150,000 group. Median household income is a significant determinant and potentially a more influential factor than neoadjuvant radiation in predicting postoperative complications after FFF reconstruction. Disparities in postoperative outcomes based on income highlight the need for substantial health care policy shifts and the development of targeted support strategies for patients with lower MHI.

Nunchaku-like Free Fibula Osteocutaneous Flap in Through-and-through Composite Oromandibular Defect Reconstruction.

The free fibula osteocutaneous flap (FFOCF) has been used for oromandibular reconstruction over several decades. However, when facing through-and-through composite oromandibular defects (COMDs), significant challenges still arise. The complexity of COMD necessitates the reconstruction of bone, intraoral mucosa, and extraoral skin. Additional flaps are often needed, which extend surgical durations and heighten associated risks. This report presents a 62-year-old man with squamous cell carcinoma of the left lower gingiva. After ablative surgery, successful reconstruction of a through-and-through COMD was achieved with a single FFOCF through innovative design. The flap was osteotomized into 2 segments with attached skin islands while preserving the vascular pedicle. Rotation of 1 segment created 2 skin islands on opposing sides, simultaneously repairing intraoral and extraoral defects. Postoperative outcomes at the 1-month follow-up were encouraging. Although technically challenging, the "Nunchaku-like FFOCF" offers a safe and effective approach for the comprehensive reconstruction of through-and-through COMD.

Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Study Design Retrospective case series. Objective Cellular bone allografts (CBAs) contain the components of a successful bone graft with no autologous component and have been used extensively outside the head and neck. Descriptions of their utilization for mandible reconstruction are limited. We review our experience utilizing a CBA, with no autologous component, for the reconstruction of mandible defects. Methods Patients undergoing reconstruction of a composite mandible defect with a CBA, no added autologous component, within a patient-specific graft cage and soft tissue free flap coverage were retrospectively identified. Graft survival and defect management are assessed and results of post-operative imaging reported. Results Five subjects, aged 23–56 years, underwent reconstruction of mandible defects with the described technique. Defects resulted from gunshot wounds in 4 patients and the composite resection of a low-grade malignancy in one. The defect was definitively managed in 4 subjects, 3 of which had post-operative imaging demonstrating bone formation. The fifth experienced graft failure after developing an orocutaneous fistula and was successful salvaged with an osteocutaneous fibula free flap. Conclusions Our early experience is promising that a CBA, with no autologous component, and soft tissue free flap coverage can be used for the reconstruction of composite mandible defects in select patients.

Early outcomes of osteofascial versus osteocutaneous fibula free flap mandibular reconstruction.

This study compares early outcomes of osteofascial fibula free flap (OF-FFF) with donor-site primary closure and osteocutaneous (OC) FFF with donor-site skin grafting in segmental mandibular reconstruction. A retrospective chart review of FFF mandibular reconstruction patients (2006-2022) divided into OF-FFF and OC-FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed. The study included 67 patients (39 OF-FFF, 28 OC-FFF). OF-FFF had significantly lower donor-site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC-FFF. Recipient-site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable. OF-FFF mandibular reconstruction with donor-site primary closure is a safe and reliable technique associated with superior donor-site and comparable flap and recipient-site outcomes to OC-FFF, thus may be considered as a viable alternative to OC-FFF for selected patients.

Complete Extensive Heterotopic Ossification of the Entire Free Fibula Flap Vascular Pedicle in Maxillary Reconstruction.

Heterotopic ossification is a pathologic extra-skeletal bone formation as a form of aberrant repair process with acquired or genetic etiologies. In plastic surgery, it has been well-described in the burn and trauma patients. Rarely, it can happen along the vascular pedicle of free tissue transfer, and when it happens, it is most commonly in head and neck reconstruction. Here we present a case of complete extensive heterotopic ossification of the entire vascular pedicle from the anastomosis to the bone in an osteocutaneous free fibula flap (FFF). The fibula was used as a 2-segment reconstruction for a maxillary defect resulting from a self-inflicted gunshot wound. The skin paddle was used to reconstruct the anterior palatal defect. Heterotopic ossification of the FFF vascular pedicle is most reported in the head and neck reconstruction cases. It is rare, but when it happens, it occurs earlier, more commonly, and more extensively in cases of maxillary reconstruction than in cases of mandibular reconstruction. Flap loss due to this sequela has not been reported, and surgical debridement is indicated only when symptomatic. Heterotopic ossification of an FFF vascular pedicle is a rare but well-described entity. The periosteal bone formation capacity preservation after revascularization of the flap is thought to be one of the major etiologies of this phenomenon. Hence, some have suggested a modification in the harvesting technique of the FFF that could mitigate return to the operating room, especially when it is for maxillary reconstruction in the trauma patient. Keywords: Keywords: free fibula flap, heterotopic ossification, maxillary reconstruction, mandibular reconstruction.

Early Weight-Bearing After Fibula Free Flap Surgery

Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery. To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status. This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included. EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later. Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups. A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99). In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery.

Radiological landmark of syndesmotic ligament complex by magnetic resonance imaging correlate with fibula free flap harvesting procedure

Preservation of syndesmotic ligaments is crucial for preventing adverse sequelae at the donor site following free fibula osteocutaneous flap harvesting. This study sought to determine the relationship between distal tibiofibular ligaments and the fibular segment to identify radiological landmarks that facilitate safe and precise flap. The distances between the distal tibiofibular ligaments (anterior inferior tibiofibular ligament [AITFL], posterior inferior tibiofibular ligament [PITFL]) and the fibular segment, as well as the lower border of the interosseous membrane, were measured on magnetic resonance imaging (MRI) scans of 296 patients without any perceivable ankle abnormalities. The mean distances (± SD) between the distal end of the fibula and the AITFL, PITFL, and lower interosseous membrane border were 3.0 ± 0.4 cm, 2.6 ± 0.4 cm, and 3.9 ± 0.6 cm, respectively. The distance between the talar dome and the PITFL exhibited a range of 0.0–0.5 cm. Our findings support preserving a distal fibular remnant of at least 4 cm to avoid injury to the syndesmotic ligament throughout fibula osteocutaneous flap harvesting. The talar dome could serve as a useful radiological landmark for identifying the upper border of PITFL during preoperative evaluation, and thus facilitating precise and safe flap procurement.

Treatment for Calcaneal Osteomyelitis with Pseudoarthrosis with a Vascularized Fibula Bone Graft and Autologous Cancellous Bone Graft: A Case Report

Calcaneal osteomyelitis with pseudarthrosis after calcaneal fracture is rare, and its treatment is challenging. We describe the use of a free fibular osteocutaneous flap to treat a 52-year-old man who presented with calcaneal osteomyelitis and pseudarthrosis after an operation for a closed comminuted fracture. The patient was previously treated with multiple surgeries and antibiotics for 8 months, but he was not cured. We performed radical osteomyelitis bone debridement and reconstruction with a free fibular osteocutaneous flap and autotrabecular bone grafting from the iliac crest. The skin flap survived, and rehabilitation was initiated early. At 2 years postoperatively, his pain and ambulatory function had markedly improved, and he could walk without problems in daily life. Free fibular osteocutaneous flap and autogenous cancellous bone grafting are considered practical options for the treatment of calcaneal osteomyelitis with pseudarthrosis.

Surgical Outcome of Free Flap Surgery in a Tertiary Referral Center in Maharashtra

Introduction: Reconstruction with a free flap is routinely done at site especially head and neck and oral because of better surgical and functional outcomes, improved esthetics results, and overall higher success rates. Aim &amp; Objective: To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions and tudy various demographic and pre-operative factors associated with it. Methods: This was a retrospective study of 45 patients undergoing reconstructions with free flaps from January 2020 to December 2022. Different types of free flap were performed like Anterolateral thigh, Free fibula osteocutaneous flap (FFOCF), free functioning muscle transfer (FFMT), Free radial artery forearm flap (FRAF), The medial sural artery perforator (MSAP), latissimus dorsi (LD), myocutaneous flap, superficial circumflex iliac artery perforator (SCIP). Results: The patients included total 45 participants, with 35 men and 10 women, with a mean age of 45.56 years. Oral malignancy was the most common cause. Squamous cell carcinoma represented the majority of the diagnosed tumors (31.1%) followed by ameloblastoma. The most common recipient vessels were the internal jugular vein (91.4%), the facial artery (77.4%) followed by superior thyroid artery. The overall flap success rate was 93.33%. Venous thrombosis was the most common cause for re-exploration. The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site on 1 month follow up. Conclusion: Microsurgical free flap seems to be a valuable and successful method in head and neck surgery. The reconstruction can be done by skilled surgeons with post-op monitoring.

235 Late Start Times Do Not Disproportionately Prolong Operating Times in Major Head and Neck Reconstruction

Abstract Introduction Operating start time delays are deemed as having a detrimental effect on theatre efficiency, subsequent delays, costs, and potentially outcomes. This study assessed the significance of delayed operating start times on major head and neck reconstruction cases and whether later starts led to disproportionately later finishes. Focus was placed on free osteocutaneous fibula flap reconstruction due to long operating times, difficult anaesthesia, frequently overrun and the perception of increased morning efficiency. Method Single centre identification of 26 patients using coding informatics that were diagnosed with an intra oral malignancy or osteoradionecrosis requiring reconstruction with a free osteocutaneous fibula flap. Data was manually retrieved between 2015 to 2020 from electronic patient records and statistical analysis was completed using Microsoft Excel. Results Total number of patients collated was 27, however 1 was excluded due to insufficient electronic logging of patient data. The total mean age was 64.8 (40-79), 50% were male (13) and 50% were female (13). The mean start time was 9:57, end time was 18:52 and duration was 10:50 (4:46 to 13:42). For surgery start times before 10:00 a.m. the mean start time was 9:31, end time was 20:16 and duration was 10:46 (8:30 to 22:56). For surgery start times after 10:00 a.m. the mean start time was 10:22, end time was 19:25 and duration was 10:54 (10:01 to 00:51). Conclusions Delayed operating start times have minimal significance on theatre efficiency and don’t disproportionally prolong operating times in major head and neck reconstruction cases.

Functional Reconstruction of Arches of the Foot With Vascularized Fibula Flap.

The skeletal integrity of the foot is as important as the soft tissue coverage of the foot. In this article, we present reconstruction of arches of foot with free fibula flap. Three patients with composite foot defects underwent reconstruction a with vascularized fibula flap. Free fibula flap was used to reconstruct the transverse arch in 2 cases and longitudinal arch in 1 case. The mean follow-up period was 3.2 years. Functional outcome was evaluated with 3-dimensional motion analyses at 12 months postoperatively. No early or late complications were encountered, and all patients were satisfied with both cosmetic appearance and functional aspects of their foot. Fibular bone showed a very healthy course without any fracture, resorption, extrusion, or migration. Three-dimensional motion analyses revealed acceptable gait capability in all cases showing successful restoration of the foot arches. As a conclusion, osteocutaneous free fibula flap can provide functional and durable reconstruction of longitudinal and transverse arches of the foot, especially if preservation of the length or the width of the foot is desired.

One-stage reconstruction using a fibula osteocutaneous free flap and an anterolateral thigh free flap for an extensive composite defect after en bloc resection of squamous cell carcinoma on the mouth floor, mandible, and anterior neck: A CARE-compliant case report.

Although regional metastasis to the lymph nodes is common in advanced oral cancer, extensive local invasion into surrounding structures such as the mandible, skin and soft tissue of the neck, and masticator space is relatively rare. Sometimes surgical treatment cannot be performed and only palliative chemotherapy and radiation therapy are offered to preserve the quality of life of patients with advanced oral cancer. Nevertheless, the surgical resection of tumors remains the most effective treatment. This study presents a case of aggressive mouth floor cancer in which extensive composite defects on the mouth floor, oral mucosa, mandible, skin and soft tissue of the neck caused by tumor resection were reconstructed. A 66-year-old man and a 65-year-old man with no significant personal or family history visited our clinic due to a large and multiple masses on the floor of the mouth and both sides of the neck. Histopathological evaluation of the biopsy specimen revealed squamous cell carcinoma. A fibula osteocutaneous free flap and customized titanium plate were used for the intraoral lining. Mandibular reconstruction was performed using a 3D-printed bone model, and an anterolateral thigh free flap was used to resurface the anterior of the neck. Reconstruction using this method was successful, and excellent functional and aesthetic outcomes were achieved without cancer recurrence. This study show that the reconstruction of extensive composite defects of the oral mucosa, mandible, and neck soft tissue following surgical resection of mouth floor cancer can be performed in a single-stage operation. Through a single-stage reconstruction, both excellent functional aspects without cancer recurrence and satisfactory aesthetic outcomes can be obtained.

Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap.

Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect. A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups. A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups (p < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF (p < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups (p < 0.05). The overall rate of complications was comparable between groups (24%, p = 0.129). The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.

Simplified Virtual Surgical Planning Method for Reconstruction of Secondary Maxilla and Mandibular Defects Using Free Bone Flap.

Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models. In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results. Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.

Intraosseous mucoepidermoid carcinoma of mandible - A rare menace in mandible

Salivary gland tumors makes up 3–4% of all head and neck cancers, mucoepidermoid carcinoma is a malignant locally recurrent variant of salivary gland carcinoma. .In this short communication we are presenting a rare entity of mandible “intramedullary mucoepidermoid carcinoma” treated with wide local excision (composite resection) with modified radical neck dissection followed by reconstruction with free fibula osteocutaneous flap.

Sensory Outcomes for Inferior Alveolar Nerve Reconstruction with Allograft following Free Fibula Mandible Reconstruction.

As patient survival with head and neck cancer has improved, treatment goals have had to evolve to focus on improving quality of life. Traditionally, patients who have undergone mandibulectomy are left with an insensate chin and lower lip secondary to resection of the inferior alveolar nerve (IAN). The purpose of this study was to critically evaluate the authors' initial experience using processed nerve allografts (PNA) for IAN reconstruction following oncologic mandibulectomy and reconstruction with free fibula osteocutaneous flaps and to assess their patients' sensory outcomes. The authors performed a retrospective review of the first 32 patients who underwent immediate IAN reconstruction with PNA at the time of oncologic mandibulectomy and mandible reconstruction with free fibula osteocutaneous flaps at The University of Texas M. D. Anderson Cancer Center over a 1-year period. Semmes-Weinstein filament sensory testing was conducted at multiple surgical follow-up appointments to evaluate the quality of sensory recovery. Thirteen of the 32 patients underwent postoperative Semmes-Weinstein filament testing. All 13 patients demonstrated partial return of sensation. At a mean follow-up of 8.33 months, the average level of sensation was 60.93% that of the unaffected side of the lower lip. Patients were consistently afforded improvement in lower lip sensation using PNA-based IAN grafting as an adjunct to free fibula-based mandible reconstruction. The procedure adds no additional surgical morbidity and has shown consistent positive results.

Refabrication of an implant-retained obturator using the denture duplication technique in a bilateral maxillectomy patient with a free fibula osteocutaneous flap.

We aimed to introduce a simple method for refabrication of an implant-retained obturator using the denture duplication technique while retaining the custom abutments for a patient who underwent bilateral maxillectomy and reconstruction with a free fibula osteocutaneous flap. We have proposed this technique to facilitate the impression-making procedure for this extensive maxillary defect and to avoid lengthy and complicated laboratory procedures. A custom tray was developed by duplicating the fitting surface of an old obturator using silicone putty. The tray was used for a bite-pressure impression wherein both definitive impression and jaw relation were obtained simultaneously, reducing the time required for the placement of a new obturator. We used the denture duplication technique to refabricate an implant-retained obturator while retaining the custom abutments. Decreased chairside time, fewer visits, the use of easily available materials, and uncomplicated laboratory procedures make this technique more economical and acceptable for patients. Using this approach, the patient was able to use the old prosthesis until the delivery of the new prosthesis. The replacement obturator that was developed using this method maintained an acceptable level of oral function.

Mini-plate versus Reconstruction Plate: A Comparative Analysis of Complications in Free Fibula Osteocutaneous Flaps for Oral Cancer

Background: Advanced Oral cancers require segmental mandibulectomy, which ideally requires fibula flap reconstruction. Mini-plates or reconstruction plates are used for fibula fixation as per the surgeon’s preference, but the complication rates of each have hardly been studied. The purpose of this study was to find the incidence of plate-related complications, the factors attributing to it, and the difference in complication rates between mini-plate and reconstruction plate for fibula flap fixation exclusively in oral cancer patients who underwent segmental mandibulectomy as part of ablative surgery. Materials and Methods: The study was a retrospective observational study of oral cancer patients who underwent free fibula osteocutaneous flap reconstruction for mandibulectomy defects from November 2010 to November 2020 at a tertiary cancer center in India. Statistical Methods: Chi-square test, Fisher’s exact test. Results: Thirty-nine patients were included in the study and the mean follow-up period was 31 months. Seventeen of them had mini-plate fixation, 16 had reconstruction plate fixation and in two patients, both were used. About 25.64% of patients had complications. In the mini-plate group, 11.7% of patients had complications whereas 44.4% had complications in the recon plate group. 9/32 patients who took adjuvant treatment had complications, and in this subset of patients, there was a significant difference in the incidence of complications between the mini and recon plate groups (P = 0.03). Conclusion: Mini-plates are associated with less complications while used for fixation in microvascular fibula osteocutaneous flaps in oral cavity malignancy who are potential candidates for adjuvant treatment.

Multi-Segmental Osteocutaneous Free Fibula Flap for Three-Dimensional Post-Traumatic Thumb and Wrist Reconstruction

Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.