Donor-Site Morbidity Following Free Fibula Flap Harvest for Mandibular or Maxillary Reconstruction in Pediatric Patients

Santamaría, Eric; Galaso-Trujillo, José Roberto; Palafox, Damián; Mainardi, Soledad Rubio; Garcia, Rigoberto Aramburo; Romero, Andrea Carrillo; Rangel, Walter Trujillo

doi:10.1097/scs.0000000000007397

Cited by 8 publications

(11 citation statements)

References 28 publications

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“…Minimal and minor sensory disturbance was reported in 9 (9/39; 23.0%) patients in this study. The previously reported rate of sensory disturbance after fibula flap harvest ranged from 5.7% to 36%; 18,23,24 our results were similar. This implies that harvesting a peroneal flap does not increase the incidence of nerve complications.…”

Section: Discussionsupporting

confidence: 87%

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

et al. 2023

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Objective Fasciocutaneous free flap based on the peroneal artery (boneless version) is an option in our practice for head and neck reconstruction. However, the associated donor-site morbidity has rarely been discussed. Thus, this study investigated the long-term patient-reported donor-site morbidity associated with peroneal flaps. Methods In this single-center, retrospective, observational study, 39 patients who underwent a free peroneal flap were enrolled. We evaluated donor-site morbidity with a modified questionnaire from Enneking et al. and Bodde et al. Results Patient-reported daily life limitation was relatively low (5/39; 12.9%). Donor-site morbidities, namely pain (4/39; 10.3%), sensory disturbance (9/39; 23.1%), and walking limitation (9/39; 23.1%) were reported; most were rated minimal in severity. Among patients with walking limitation, muscle weakness (3/39; 7.7%), ankle instability (6/39; 15.4%), and gait alternation (6/39; 15.4%) were reported. Six patients developed claw toe. Conclusion Balancing successful reconstruction and donor-site morbidity is challenging. This long-term patient-reported survey revealed that harvesting peroneal flaps resulted in minimal or minor donor-site morbidity with no obvious impacts on the patients’ daily quality of life. Although free radial forearm flaps and anterolateral thigh flaps are standard, free peroneal flaps have been proven reliable, with acceptable donor-site morbidity.

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Section: Discussionsupporting

confidence: 87%

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

et al. 2023

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“…9 In addition, relatively high rates of donor site morbidity of FVFG have been reported in younger individuals. 10 Taken together with the above data, reconstruction with frozen autografts alone may be worth considering for initial reconstruction in the upper limb in teenagers, as in case 1. Primary fibular flap reconstruction may have been preferable in case 2.…”

Section: Discussionmentioning

confidence: 87%

Vascularized Fibular Grafts for Failed Liquid Nitrogen–treated Autografts in the Humerus: Report of Two Cases

Fujisawa

Miyamoto

Kobayashi

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: With advances in chemotherapy and surgical techniques, limb salvage and biological reconstruction, including autologous bone grafting, have become the preferred treatment options for primary malignant bone tumors of the extremities. Although autografts, which involve recycling of tumor-bearing bones, have the advantages of easy accessibility and anatomical matching, fracture is a frequent major complication. However, to our knowledge, salvage of refractory autograft failure has not yet been reported. This report describes free vascularized fibular graft implantation for salvaging failed previous reconstructions. We describe two patients (a 4-year-old girl and a 30-year-old man, respectively) with primary malignant bone tumors. Liquid nitrogen-treated autografts had been used to reconstruct the humerus in both cases. The patients sustained autograft fractures that could not be treated conservatively or by internal fixation. Free vascularized fibular grafts were transferred as double-barrel inlay grafts (length 7.2 and 8.2 cm) and a single-strut onlay graft (length 16 cm). The brachial arteries, brachial veins, and cephalic veins were used as recipient vessels. Bone union between the fibular grafts and humerus was achieved after 29 and 15 months of follow-up, respectively. In conclusion, free vascularized fibular grafts can be used to salvage refractory autograft fractures.

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“…However, vascularized-free fibula harvest has been reported to have a high donor-site morbidity rate in children. [13][14][15][16] The fibula has been reported to have minimum limb function recovery in adult patients. However, in children, valgus deformity after vascularized fibular graft harvest was highlighted in a report, with an incidence of 7% to 45%, especially in younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, vascularized-free fibula harvest has been reported to have a high donor-site morbidity rate in children 13–16 . The fibula has been reported to have minimum limb function recovery in adult patients.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Mandibular Reconstruction With Free Serratus Anterior-Rib Composite Flap

Tai

2023

Ann Plast Surg

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Reconstruction of children's mandibles after mandibular resection for benign or malignant tumors is challenging. Microvascular flap reconstruction is a common treatment option for restoring mandibular continuity after the resection of oral cavity neoplasms.We presented 2 cases of childhood mandibular reconstruction after tumor wide excision and segmental mandibulectomy, one for malignant cancer and one for benign ossifying fibroma, with serratus-rib composite free flap. All 2 patients had a favorable facial profile, functional outcome, and dental occlusion at the last follow-up. The development of children's mandible and donor site needs to be considered compared with adult's mandibular reconstruction. Given its reliability and utility, this flap can be an alternative for pediatric mandibular reconstruction compared with the free fibular flap and other candidates.

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Donor-Site Morbidity Following Free Fibula Flap Harvest for Mandibular or Maxillary Reconstruction in Pediatric Patients

Abstract: Implant-retained prostheses for facial defects: an up to 14-year follow-up report on the survival rates of implants at UCLA.

Cited by 8 publications

References 28 publications

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

Vascularized Fibular Grafts for Failed Liquid Nitrogen–treated Autografts in the Humerus: Report of Two Cases

Pediatric Mandibular Reconstruction With Free Serratus Anterior-Rib Composite Flap

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