Free vascularised fibular flap harvesting in children: An analysis of donor-site morbidity

Barla, Manuela; Polirsztok, Eva; Peltié, E.; Jouve, J.-L.; Legré, R.; Dautel, G.; Barbary, S.; Journeau, Pierre

doi:10.1016/j.otsr.2017.05.009

Cited by 17 publications

(21 citation statements)

References 25 publications

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“…Our 44.8% overall complication rate is similar to that reported by other studies within the pediatric population (25-100%). 4,7,12,14,17,[20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37] One exception is our rate of neurologic injury (3.4%), which is much lower than other published reports. While most frequently seen as a donor-site complication, the single neurologic complication in our series was in the recipient site, where the patient experienced a deep peroneal nerve palsy secondary to postoperative swelling.…”

Section: Discussionmentioning

confidence: 91%

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

McCullough

Arkader

Ariani

et al. 2020

J Reconstr Microsurg

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Background In the pediatric population, bony defects of the extremities pose a significant challenge for which free vascularized fibular grafts (FVFGs) represent a valuable reconstructive option. The purpose of this study was to explore surgical outcomes, complications, and long-term functionality of FVFG for this patient group. Methods Using MEDLINE and PubMed databases, studies were identified of pediatric extremity reconstruction using FVFG which reported functional outcomes and/or complications. The operative logs at a tertiary pediatric center were then reviewed for cases of FVFG between January 2000 and 2017. Demographic characteristics, surgical indications, operative details, graft survival, bony union, complications, and functionality of the reconstruction were recorded. Results A total of 366 studies were identified with 23 ultimately meeting inclusion criteria in the systematic review. In the institutional series, 29 patients were included with mean age of 9.7 years (1–17 years). Indications for reconstruction included malignant bone tumor (n = 11), osteomyelitis (n = 9), congenital pseudoarthrosis (n = 6), and osteofibrous dysplasia (n = 3). Major postoperative complications included graft nonunion (24.1%), fracture (17.2%), and hardware failure (17.2%). Thirteen patients (44.8%) experienced delayed complications, while two (6.8%) experienced an immediate complication. Complications occurred in the donor site in 2 cases and the recipient site in all 13 cases. Long-term graft survival was achieved in 27 patients (93.1%), and 23 (79.3%) had full functional recovery, with an average Musculoskeletal Tumor Society score of 90% (60–100%). Mean follow-up was 5.17 years (2–12 years). Conclusion This review and institutional series demonstrate the versatility of FVFG to facilitate limb reconstruction in large defects or serve as a salvage option in complex cases. While immediate and donor-site complications are uncommon, delayed recipient-site complications are frequent, and patients and families should be counseled regarding this expectation. Though technically challenging, excellent long-term graft viability and functional recovery can be achieved in the large majority of patients.

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Section: Discussionmentioning

confidence: 91%

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

McCullough

Arkader

Ariani

et al. 2020

J Reconstr Microsurg

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“…The free fibular flap is a well-established hard tissue reconstruction technique for adults and children. A fibular flap harvest may have a potential valgus deformity and lower limb morbidity 13,14 . We chose a free serratus anterior rib composite flap for these 2 cases of mandibular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…The mandibular defects directly affect the facial features, masticatory and articulation functions of the patient 11 . This damage also restricts the daily life and social activities of the patients to different degrees, and indirectly affects the psychological state and social activities of the patients 12 .…”

Section: Discussionmentioning

confidence: 99%

The role of folded fibular flap in patients’ reconstruction of mandibular defects: a retrospective clinical study

Gao

Cai

et al. 2021

Sci Rep

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This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.

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Free vascularised fibular flap harvesting in children: An analysis of donor-site morbidity

Abstract: IV.

Cited by 17 publications

References 25 publications

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

Pediatric Mandibular Reconstruction With Free Serratus Anterior-Rib Composite Flap

The role of folded fibular flap in patients’ reconstruction of mandibular defects: a retrospective clinical study

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