Free fibular flap with periosteal excess for mandibular reconstruction

Abstract

The use of a periosteal excess at both ends of the fibula flap provides better blood supply and is, therefore, able to ensure good bone healing and skin paddle survival regardless of the radiotherapy.

Sequential evaluation for bone union of transferred fibula flaps in reconstructed mandibles: panoramic X-ray versus computed tomography

“…13 Prompt wound healing, including bone union, is also necessary for timely adjuvant therapy 4 and for early resumption of oral intake and mastication after surgery. Postoperative confirmation of bone union is essential before the placement of Defects that include neither A nor T are defined as defects of the 'body' (*).…”

“…All fibulae used in mandibular reconstruction were covered in periosteum, with additional periosteum from the donor site present at both ends. 4 Transferred fibulae were positioned in alignment with the lower border of the residual mandible as a mono-barrel graft. To restore facial contour, fibular osteotomies were performed only at the 'T' and 'A' positions, described in detail below (Fig.…”

“…Good bone union is necessary to allow timely postoperative radiation therapy after cancer resection. 4 Dental rehabilitation with osseointegrated implants in reconstructed mandibles contributes to the restoration of both function and aesthetics. 5 Good bone union is also essential for dental implant placement and prosthesis use in reconstructed mandibles.…”

“…Therefore, three-dimensional CT scans were used in that study to visualize variations in bone union of fibula free flaps. 4 The purpose of this study was to sequentially evaluate long-term (2 years postoperatively) bone union of transferred fibula flaps in mandibular reconstruction, and to determine adequate methods for evaluating bone union in neomandibles by comparing radiological findings on panoramic X-ray and CT.…”

The anatomical investigation for harvesting various chimeric flaps based on the peroneal artery

“…14 The vascularized periosteal graft has been established with the ability to enhance bone union with its osteogenic and angiogenic property both in animal experiments and clinical practice. [15][16][17][18] Consequently, we demonstrated in this study the feasibility of harvesting the fibular segment along with the periosteum nourished by the periosteal branches of the peroneal artery in the distal part of the tibia and fibula, developing the novel chimeric fibular osteo-cutaneo-periosteal flap, which would have the following advantages: 1. the periosteal component can be wrapped around the contact between the bone graft and the recipient bone, achieving a better soft tissue coverage, which can prevent the ingrowth of the cicatricial tissue as well as considerably enhance local vascularization; 2. the cambium layer of the periosteal component in direct contact around the graft-host contact can strongly augment the bone union with its osteogenic ability.…”