Anatomic basis for an algorithmic approach for free fibula flap donor side selection in composite oro-mandibular defects

Abstract

Introduction:Head and neck oncological resections may result in composite oro-mandibular defects involving the oral mucosa (lining), mandibular bone and the skin (cover). Reconstructive options for such defects have evolved over a period. Free fibula flap reconstruction is currently accepted the world over as the gold standard for oro-mandibular defect reconstruction. Existing literature provides conflicting views about the use of a particular side and orientation of the fibula flap for achieving the optimal outcome. The purpose of this study is to confirm anatomically the effect of bone, soft tissue and vessel orientation on the ease of doing reconstruction.Materials and Methods:This is a cadaveric study. A mandibular model with a defect was used. This was pre plated to maintain continuity. Composite fibula flaps of the same dimension were harvested from both legs of a fresh cadaver. The harvested flaps were used to reconstruct the mandibular defect in different orientations and the best configuration for each reconstructive requirement was assessed.Results:Keeping the peroneal surface for plating, that is, facing outwards, four different configurations of the fibula flap are possible for a given mandibular defect. With a posterior vascular pedicle ipsilateral fibula is suitable for skin cover and contralateral for mucosal lining and the reverse for an anteriorly placed pedicle.Conclusion:The algorithm based selection of appropriate sided fibula flap facilitates complex mandibular reconstruction by placing the right kind of tissue at the right place and helps in reducing the donor site morbidity by allowing the surgeon to harvest only the required amount of skin.

Strategy for preventing skin paddle necrosis in mandibular reconstruction with free fibula osteocutaneous flap

“…The other alternative to overcome incorrect laterality would be to relieve the overstress of the cutaneous perforator and skin paddle by enlarging the latter. In a cadaveric study (Sharma et al, 2015), it was reported that when the skin paddle was passed through the outside of the reconstruction plate, approximately 3–4 cm of the skin paddle's width was required to be larger than when it was not passed through the outside of the plate. Considering this, it would be necessary to use a skin paddle that is at least 3 cm wider than the area of the defect when the laterality is incorrect.…”

Colgajos Microvascularizados en Reconstrucción Maxilofacial: Avances de la Microcirugía

“…Esto debido a las variadas ventajas que posee tales como la gran versatilidad de prestar tejido óseo, óseo más pedículo fasciocutáneo cutáneo, además de presentar un hueso de mayor extensión y ancho que los otros nombrados. Donde existen diversos algoritmos de reconstrucción y útil tanto en mandíbula como en maxila (Serra et al;Sharma et al, 2015;Kokosis et al, 2016), no obstante lo anterior el colgajo radial ha sido ampliamente utilizado desde su incorporación en 1971 (Liu et al, 2008;Jeremic & Nikolic).…”

Sequential treatment from mandibulectomy to reconstruction on mandibular oral cancer – Case review I: mandibular ramus and angle lesion of primary intraosseous squamous cell carcinoma

“…Supraomohyoid neck dissection (SOHND) was performed at our hospital on the right side along with wide excision and segmental mandibulectomy. This patient had an intraoral defect and ipsilateral neck vessels, so a contralateral fibular free flap was chosen to cover the intraoral defect and resected mandible areas 8 . Mandibular ramus reconstruction with a two-piece fibular free flap was carried out after mandibular resection.…”

“…( Fig. 8 ) This patient also had an intraoral defect and ipsilateral neck vessels, so a contralateral fibular free flap was chosen 8 . After resection, mandibular reconstruction was carried out using a fibular free flap.…”

“…A Mandibular Reconstruction Angled Plate (Stryker, Kalamazoo, MI, USA) was prepared preoperatively using a rapid prototype model and was used as the reconstruction plate after being cut according to the bone resection site.(Fig. 8) This patient also had an intraoral defect and ipsilateral neck vessels, so a contralateral fibular free flap was chosen 8 . After resection, mandibular reconstruction was carried out using a fibular free flap.(Fig.…”