From bench to bedside – current clinical and translational challenges in fibula free flap reconstruction

Abstract

Fibula free flaps (FFF) represent a working horse for different reconstructive scenarios in facial surgery. While FFF were initially established for mandible reconstruction, advancements in planning for microsurgical techniques have paved the way toward a broader spectrum of indications, including maxillary defects. Essential factors to improve patient outcomes following FFF include minimal donor site morbidity, adequate bone length, and dual blood supply. Yet, persisting clinical and translational challenges hamper the effectiveness of FFF. In the preoperative phase, virtual surgical planning and artificial intelligence tools carry untapped potential, while the intraoperative role of individualized surgical templates and bioprinted prostheses remains to be summarized. Further, the integration of novel flap monitoring technologies into postoperative patient management has been subject to translational and clinical research efforts. Overall, there is a paucity of studies condensing the body of knowledge on emerging technologies and techniques in FFF surgery. Herein, we aim to review current challenges and solution possibilities in FFF. This line of research may serve as a pocket guide on cutting-edge developments and facilitate future targeted research in FFF.

Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes

“…The repetitive bending of the plates may also result in increased fatigue and less resistance to corrosion, increasing the risk of plate fracture. Additionally, inappropriate selection of plate size or improper placement can create stress concentrations and is a crucial risk factor 2 , 15-17 . According to the literature, it is reported that plate fractures occur in 2.9%-10.7% of cases, with most occurring within 2 years after surgery, and often within less than 6 months 2 .…”

“…Although there may be some variations in the parameters proposed, the literature generally agrees that CAD/CAM-guided reconstruction provides greater accuracy and precision compared to traditional methods 2 . The restoration of the proper shape and correct relationships between the mandibular and maxillary bones can result in adequate support for the soft tissues of the face, restoration of symmetry, and in cases of maxillary defects, support for the nasal pyramid and orbital content 15-17 . Furthermore, the restoration of normal occlusal relationships and the position of the mandibular condyles in the glenoid fossa is crucial.…”

Segmental Mandibulectomy and Mandibular Reconstruction with Fibula-Free Flap Using a 3D Template

“…Virtual surgical planning has been developed to optimize reconstructive outcomes. Preoperative 3D virtual modeling of skulls created using preoperative computed tomography (CT) scans allows the surgeon to model the titanium plate before surgery, simplifying the intraoperative steps and decreasing operative time [8][9][10][11][12]. This protocol was first described in 1993 by Rose et al [13] and it became a milestone in the history of mandibular reconstruction.…”