Fibula free flap mandible reconstruction

✍ Scribed by David A. Hidalgo

• Book ID: 102947959
• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 723 KB
• Volume: 15
• Category: Article
• ISSN: 0738-1085
• DOI: 10.1002/micr.1920150404

✦ Synopsis

Free flaps have many proven advantages in mandible reconstruction. 1-3 Recently, the fibula has become a popular donor site choice for this purpose. It has many attractive features, is versatile, and has few drawback^.^-^ It provides up to 25 cm of bone, enough to reconstruct a mandible defect of any length. The bone has a consistent shape throughout its length, a feature that makes it ideal bone stock for shaping a mandible graft. The blood supply parallels the course of the bone, an arrangement that guarantees adequate vascularity to all segments of a multiply osteotomized graft. The flexor hallucis longus muscle, largely expendable, also courses with the bone and is conveniently located to fill in soft tissue loss adjacent to the bone, usually under the mandibular border. A skin island, based on a septocutaneous blood supply, is available in a size large enough to simultaneously reconstruct internal and external soft tissue defects. The skin blood supply, previously believed to be tenuous, is actually reliable in 91.5% of pat i e n t ~. ~

The fibula is located far enough from the head to allow a separate team to work simultaneously in each area without encroaching on one another. Positioning is not a problem because the fibula can be efficiently dissected in the supine patient. Finally, fibula donor site morbidity is low.

INDICATIONS

The versatility of the fibula makes it the flap of choice for the majority of mandible defects. It is equally well suited to short segment "bone-only'' defects, anterior reconstructions requiring both external skin replacement as well as floor of mouth replacement, and hemimandible defects with adjacent lateral floor of mouth or buccal mucosa 1 0 ~s . ~ Its only disadvantage is that the skin island is not reliable in every patient.

There are only two specific situations where another