Microvascular Fibular Flap Research Articles

Economic analysis of a low-cost virtual surgical planning protocol for mandibular reconstruction: a case series

The aim of this study was to make an economic analysis and evaluation of a low-cost virtual surgical planning (VSP) protocol that was developed in house, and based on open-source software and a desktop 3-dimensional printer. All eight patients between April 2014 and 2015 who had been treated by mandibular reconstructions with microvascular fibular flaps that had been planned using the protocol were retrospectively analysed for accuracy, time, and cost. Median differences for planned compared with postoperative intercondylar distance, intergonial distance, and gonial angle did not differ significantly. A median (range) labour time of 85 (€57-124) minutes was needed. An evaluation of cost, including labour, showed an additional median (range) cost/patient of € 276 (€257.50-297.25). With the acquisition cost of the 3-dimensional printer omitted, there was a negligible additional cost/patient of €44.75 (€26.25-66). All planning was done by the junior surgeon and there was a steep learning curve. Our new VSP protocol is cost-effective, easy to use, and has an accuracy comparable with that of a standard VSP protocol. To the best of our knowledge this is the first report of an open-source software protocol in which the labour costs of the planning by a surgeon are included.

Reconstruction of the midface with parallel segmentation of the microvascular fibular flap: a new technique

Background: Maxillectomy for tumour removal causes a extensive facial defect. Midface reconstruction is challenging and each case has its diferences.

Precision of Simultaneous Guided Dental Implantation in Microvascular Fibular Flap Reconstructions With and Without Additional Guiding Splints

Dental rehabilitation in patients receiving free flap reconstructive surgery on the mandible or maxilla is an important part of bringing patients back to normality in both a physical and psychological way. It is therefore important to be able to do this in the fastest way possible. Virtual preplanned reconstructions of jaws with implants placed simultaneously are a good way to expedite this process and have the advantage of allowing true backward planning to achieve bone placement where it prosthetically needs to be. Thus, the precise transfer of the virtually preplanned implant position to the intraoperative situation is crucial for prosthetic rehabilitation. We compared a control group of patients (4 patients with 15 implants) with preplanned fibular reconstructions of the mandible with implants incorporated in the planning and a trial group of patients (4 patients with 13 implants) with an additional intraoperative splint for the verification of the implants' angulation. The preoperative planning and postoperative computed tomography scans were compared. The average positioning error at bone level was 0.9mm in the trial group and 1.3mm in the control group. The average angulation error in the buccolingual plane was 2.9° in the trial group and 5.5° in the control group; axially, the difference was 6.3° in the trial group and 4.1° in the control group. The use of digitally backward-planned fibula cutting guides with direct dental implant positioning is feasible, and the precision found is comparable with that of standard splint-guided implant placement in the general population. Although the axial angulation error has more to do with anatomic variance and positioning of the bony cutting guide, the trial population clearly profited from the additional splint in the important buccolingual angulation. Overall, we showed a high level of precision over all implants in both groups.

Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap.

The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.

Application of Intraoperative Navigation for the Reconstruction of Mandibular Defects With Microvascular Fibular Flaps-Preliminary Clinical Experiences.

A microvascular fibular flap is the main option for the reconstruction of mandibular defects. This paper introduces an innovative strategy for the accurate fabrication of fibular flaps. Nine patients with mandibular tumors were included in this study. The mandibular reconstruction planning was performed using MIMICS 10.01. One reconstruction plate was preformed. During the operation, the fibular flap was fabricated and implanted using the BrainLab navigation system. Six to 12 months after surgery, computed tomography data were acquired and compared with preoperative planning. The osteotomy of the fibular flap and the mandible was easily performed, using the navigation and the osteotomy template respectively. The preformed plate accurately determined the position of the flap. The treatment outcome was consistent with the preoperative planning using 3D analysis. Combination of the intraoperative navigation and preformed plate technique demonstrated great practical value in mandibular reconstruction with microvascular fibular flaps.

Versatility of the microvascular fibular flap in limb reconstruction

Abstract Background The structural characteristics of the fibula, strength, shape, length and limited donor site morbidity make it more suitable for reconstructing long bone defects larger than 6 cm in the limbs. Material and methods A descriptive study was conducted using a non-probabilistic sample of consecutive cases undergoing on limb reconstruction with free fibular flap in the period from January 2010 to January 2015 in the Mexican Institute of Social Security No. 21, Monterrey, Nuevo Leon. Results The mean age of the ten cases included was 25 years, with the most common diagnosis being trauma in 4 patients, osteosarcoma in 2, followed by one congenital pseudoarthrosis of the tibia, one non-union fracture, and one gunshot wounds, respectively. The most common location was tibia, followed by humerus, radius, ulna and femur. Conclusions This study has shown that the fibular free flap can be an excellent option for management of long bone defects, regardless of cause of the injury. One or more skin islands can be added for coverage in exposure of deep tissue and osteosynthesis material, thus preserving the septocutaneous perforators.

Free microvascular transfer of segmental corticocancellous femur for alveolar ridge reconstruction

e thank the University Hospital Birmingham for their ongratulations concerning our article “Free microvascular ransfer of segmental corticocancellous femur for alveolar idge reconstruction”.1 We would like to answer some important questions about he technique for harvesting this flap and to explain our reaons for its use in maxillofacial reconstruction. Up to now e have used 18 of these flaps for maxillofacial patients and ore than 50 for reconstructive hand surgery in association ith our trauma department.2 There were no fractures of the emur in more than 68 cases after using small transplants. The Birmingham group is right to comment that fractures ill occur when large sections of the femur, which reduce its ircumference by more than 35%, are taken. We did not do his. When a large transplant is necessary, we prefer to use nother type of flap such as the microvascular fibular flap, therwise prophylactic plating is necessary. We have also sed the microvascular osteocutaneous radius, but are not as appy with this because there is less bone available, and a igh incidence of fractures when not plated prophylactically. e agree that prophylactic plating should be done every time steocutaneous radial flaps are used.3 There is more cancelous bone in the condyle of the femur so this is where most f the transplant is taken from. We described only the osteoperiosteal bone transplant in ur article in this journal, but we reported use of the comosite flap made from the medial femur (including the femur one flap) and the saphenous soft tissue flap in the Journal of econstructive Microsurgery earlier this year.4

Mandibular reconstruction with microvascular fibular flaps after large resections: Towards a functional and cosmetic goal

Reconstruction after resection for intraoral malignancies has improved significantly following the widespread use of micro vascular flaps. Mandibulectomy involving more than a small segment of the bone will always leave a significant cosmetic and functional defect. Reconstruction with skin and soft tissue flaps alone results in considerable deviation of the jaw, difficulties in mastication and speech and a less than ideal result. Vascularised bone transfers have now become the mainstay of reconstruction in such defects and the free fibular transfer has become the flap of choice worldwide. The requirements are usually for combinations of loss of bone, lining, cover and soft tissue for volume. In this paper, we present our consecutive series of 59 patients who underwent a free fibula transfer for reconstruction after mandibulectomy where the defect involved loss of more than 2 components outlined above. The indications, details of the defects, modifications of the surgical technique, complications, and donor site morbidity and outcome are discussed and the literature reviewed. The free fibular osteocutaneous flap appears to be the ideal flap for postmandibulectomy defects due to its reliability, versatility and ability to be contoured to the mandibular shape as well as the associated amount of skin and soft tissue that can be harvested with it.

Mandibular Reconstruction with Microvascular Fibular Flaps After Large Resections

Mandibular Reconstruction with Microvascular Fibular Flaps After Large Resections

A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap.

The temporomandibular joint is occasionally encountered in extirpative surgery of the head and neck. It presents a difficult management issue. Little has been reported on functional outcomes after resection and reconstruction of the temporomandibular joint. A retrospective analysis consisting of chart reviews and phone interviews was performed on 17 patients who underwent fibular free flap reconstruction of the temporomandibular joint from 1993 to 1998. Mean follow-up in surviving patients (10) was 41.3 months. Mean age of the group was 62; male-to-female ratio was 11:6. Average hospital stay was 11.6 days. Four patients had no radiation therapy, 2 had preoperative and 11 had postoperative treatment. Five patients had one osteotomy, seven had two, one had three, and one had four. Ten patients could chew, one could not, and none were recorded for the remaining. Diet consisted of regular food for two patients, soft food for seven, full liquids for four, and tube feeds for four. Cosmesis was judged as excellent by eight patients, acceptable by two, and unacceptable by two. Five patients did not describe cosmesis. Most patients stated that bony contour was excellent, but that the soft tissue defect was noticeable. Speech was judged as intelligible by seven and moderately understandable by one. Nine patients did not describe speech. Two patients had postoperative displacement of the fibular head out of the fossa. Primary reconstruction of the temporomandibular joint with microvascular fibular flaps is a viable and effective means of restoring function. The majority of patients are able to resume oral feeds, obtain excellent or pleasing cosmetic results, and maintain intelligible speech.