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

Parise, Guilherme Klein; Guebur, M.I.; Ramos, Gyl Henrique Albrecht; Groth, Anne Karoline; Silva, Alfredo Benjamin Duarte da; Sassi, Laurindo Moacir

doi:10.1007/s10006-018-0701-2

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…In our third case we worked in collaboration with maxillofacial surgeons. In such procedures, a bone resorption can be observed in allografts, especially after radiotherapy in the postoperative period [ 55 ]. The plates used are not sufficiently strong and ultimate solutions for the temporomandibular joint cannot be found.…”

Section: Discussionmentioning

confidence: 99%

The Possibilities of Personalized 3D Printed Implants—A Case Series Study

et al. 2023

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Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.

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Section: Discussionmentioning

confidence: 99%

The Possibilities of Personalized 3D Printed Implants—A Case Series Study

et al. 2023

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“…Similarly, a metaanalysis including 511 patients showed no differences in the use of these two systems of xation; however, clinical records showed that reconstruction plates were associated with both less complications and local exposure in the postoperative period than miniplates [21]. Parise et al retrospectively evaluated 43 patients submitted to mandibular reconstruction with free bular ap [22]. In the two cases in which system 2.4 reconstruction platers were used for xation, the plate was exposed to the oral cavity during the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Thirty-eight-year Follow-up of the First Patient of Mandibular Reconstruction with Free Vascularized Fibula Flap

Puricelli

Chem

2021

Preprint

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Background: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction.Case presentation: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

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“…Flap failure appears in up to 13% in most reports. 2,7,10,[15][16][17][18] Operative outcome and complications are multifactorial and are patient and surgical team dependent. During the study period, we have found a statistically significant improvement in overall flap success rates with flap failure decreasing from 28% in early years to 8% in the recent decade.…”

Section: Discussionmentioning

confidence: 99%

“…Flap failure rates range between 0 and 13% in the majority of reports. 2,7,10,[15][16][17][18] During our 21-year experience with the FFF for head and neck reconstruction, we have performed several key changes in presurgical planning, surgical technique, and postoperative monitoring. The aim of this study was to describe the demographics, operative, and postoperative course of this cohort of patients, describe the changes we performed in our practice and assess trends in outcome.…”

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confidence: 99%

The Evolution of the Free Fibula Flap for Head and Neck Reconstruction: 21 Years of Experience with 128 Flaps

Fliss

Yanko

Bracha

et al. 2020

J Reconstr Microsurg

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Background The free fibula flap is commonly referred to as a “workhorse” for head and neck reconstruction. During our 21-year experience with this flap, we have performed several changes in preoperative planning, operative technique, and postoperative follow-up. Patients and Methods A retrospective cohort study designed to analyze the cohort of patients who underwent free fibula transfer for head and neck reconstruction. Demographics, medical background, operative data, and postoperative outcome were collected. The changes we performed in preoperative planning, operative technique, and postoperative follow-up were assessed and their impact on outcome discussed. Results During 1998 to 2019 a total of 128 free fibula flaps were transferred for head and neck reconstruction. When comparing the patients treated in the early years to those who were treated in recent years we found no statistically significant difference in minor or major nonmicrosurgical complications in the recipient and donor site and in the rate of take backs due to microsurgical reasons. However total flap failure rate improved from 28% in early years to 8% in recent years (p = 0.012). Conclusion During this 21-year period, we performed several changes in our practice. This included the use of a three-dimensional (3D) prefabricated model of the mandible, a shift toward side-table osteotomies, increasing the rate of osteofascial flaps in contrast to osteocutaneous flaps and the use of an implantable Doppler. These changes, together with a learning curve of the surgical team, significantly improved our overall success rates.

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

Cited by 14 publications

References 18 publications

The Possibilities of Personalized 3D Printed Implants—A Case Series Study

The Possibilities of Personalized 3D Printed Implants—A Case Series Study

Thirty-eight-year Follow-up of the First Patient of Mandibular Reconstruction with Free Vascularized Fibula Flap

The Evolution of the Free Fibula Flap for Head and Neck Reconstruction: 21 Years of Experience with 128 Flaps

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