• Archives of Plastic Surgery
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• 제46권5호
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• pp.426-432
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• 2019

Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.14.1-14.10
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• 2019

Background: Condylar dislocation can arise as a complication in patients who required mandibular and/or condylar reconstruction and were operated on with fibula free flap (FFF) using surgical guides designed using simulation surgery. Surgeons should be aware of the complications in these present cases when planning and performing reconstructions as well as predicting prognoses. Cases presentation: Two cases showed condylar dislocation in mandibular reconstruction using a FFF fixed with a reconstruction plate. Three cases showed condylar dislocation in mandibular reconstruction using a fibula free flap fixed with a mini-plate. Conclusion: Despite the lack of clinical symptoms in these cases following mandibular reconstruction using an FFF, the mandibular condyle was severely displaced away from the glenoid fossa. A surgeon must have sufficient time to consider the use of a long flap with thickness similar to that of the mandible, ways to minimize span and bending, and methods of fixation. The patient, moreover, should be educated on condylar dislocation. Customized CAD/CAM-prototyped temporomandibular condyle-connected plates may be a good alternative even if virtual simulation surgery is to be performed before surgery. These considerations may help reduce the incidence of complications after mandibular reconstruction.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.90-93
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• 2015

The fibula free flap has now become the most reliable and frequently used option for mandible reconstruction. Recently, three dimensional images and printing technologies are applied to mandibular reconstruction. We introduce our recent experience of mandibular reconstruction using three dimensionally planned fibula free flap in a patient with gunshot injury. The defect was virtually reconstructed with three-dimensional image. Because bone fragments are dislocated from original position, relocation was necessary. Fragments are virtually relocated to original position using mirror image of unaffected right side of the mandible. A medical rapid prototyping (MRP) model and cutting guide was made with 3D printer. Titanium reconstruction plate was adapted to the MRP model manually. 7 cm-sized fibula bone flap was designed on left lower leg. After dissection, proximal and distal margin of fibula flap was osteotomized by using three dimensional cutting guide. Segmentation was also done as planned. The fibula bone flap was attached to the inner side of the prebent reconstruction plate and fixed with screws. Postoperative evaluation was done by comparison between preoperative planning and surgical outcome. Although dislocated condyle is still not in ideal position, we can see that reconstruction was done as planned.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.44-48
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• 2000

The advent of free bone flaps has made successful replacement of extensive areas of bone loss in the upper and lower extremities. The microvascular free bone flaps have faster healing without bony absorption or atrophy and can heal in the hostile environment of scarred bed or infection. Since the fibula free flap introduced by Taylor and colleague in 1975, it has been used extensively for skeletal reconstruction of extremities. In 1988, the folded vascularized fibula free flap was first described as a technique to reconstruct significant long bone defect of upper and lower extremities. During the same time, the fibular free flap has evolved to become most preferred choice of mandibular reconstruction. Up to present day, few reports have been made on the fibular free flap used for reconstruction of injured hand containing metacarpal bone and soft tissue defect. We present here our new and unique experiences with vascularized fibular osteocutaneous free flap as useful and satisfactory one for reconstruction of hand with composite defects.

• 대한두개안면성형외과학회지
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• 제22권2호
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• pp.105-109
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• 2021

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.1-10
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• 2002

Purpose : To analyze the clinical results of free vascularized osteocutaneous fibula graft to tibial defect combined with soft tissue defect and infection. Materials and Methods : In the retrospective study of 51 consecutive cases of vascularized osteocutaneous fibular graft, the length of the grafted fibula, size of the skin flap, anastomosed vessels, ischemic time of the flap, time for union, hypertrophy of fibula and the complications were evaluated. Results : Initial bony union of the grafted fibula was obtained at 3.74 months after operation, except 4 cases of nonunion and delayed union. The weight bearing without external supports was possible at 18 months after operation in average. The fracture of grafted fibula was most common complication(16 cases). Conclusion : The vascularized osteocutaneous fibula graft provided satisfactory bony union and functional results in the cases not responsible for conventional treatment methods.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.76-79
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• 2015

One of the most serious complications after head and neck radiation is osteoradionecrosis (ORN) of the jaw. The etiology of ORN is extraction, minor dental procedure or dental implant surgery. When ORN of the jaw progressed to stage III, free fibular flap is the most useful methods for reconstruction. In this case report, a 67-year-old ORN patient who underwent fibular free flap reconstruction using simulation surgery with 3-dimensional rapid prototype (3D RP) model was reviewed. After partial mandibulectomy, a osteocutaneous fibula flap was used for reconstruction. Oro-cutaneous fistula was resolved after operation. Patients reported improved food intake after operation without pus discharge. Functional and esthetic results showed successful reconstruction.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.253-257
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• 2022

The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권3호
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• pp.216-223
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• 2021

Preoperative patient analysis for oral cancer involves multiple considerations that are based on multiple factors; these include TNM stages, histopathologic findings, and adjacent anatomical structures. Once the decision is made to excise the lesion, the margin of dissection and its extent should be considered along with the best form of reconstruction and airway management. Treatment methods include surgical resection, radiotherapy, and chemotherapy. Although the combined method of treatment is controversial, surgical resection is considered predominantly, and immediate reconstruction after surgical resection follows. The choice of treatment is dictated by the anticipated functional and esthetic results of treatment and also by the availability of a surgeon with the required expertise. Segmental mandibulectomy with primary reconstruction has been shown to have advantages in both functional and esthetic results. A 52-year-old male patient with basaloid squamous cell carcinoma of the floor of the mouth, and the anterior portion of the mandible was treated with surgical procedures that included segmental mandibulectomy with both supraomohyoid neck dissection (SOHND) at Levels I-III and mandible reconstruction with a left fibula free flap. A 55-year-old male patient with clear cell odontogenic carcinoma of the oral cavity underwent segmental mandibulectomy with both SOHND at Levels I-III and mandible reconstruction with a left fibula free flap. The purpose of this study was to review the anatomic and functional results of patients after immediate reconstruction with a fibula free flap following resection of carcinoma in the anterior portion of the mandible and floor of the mouth.