Use of the “double barrel” free vascularized fibula in mandibular reconstruction

Bähr, Wolfgang; Stoll, Peter; Wächter, Rudolf

doi:10.1016/s0278-2391(98)90914-4

Cited by 163 publications

(100 citation statements)

References 40 publications

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“…tissue (that enhances tongue mobility, speech, swallowing and subsequent dental rehabilitation). [15][16][17][18] Osseous free flaps for mandibular reconstruction can be obtained from the fibula, ilium, scapula, rib, metatarsus and radius. 15,17 FFF provides several advantages over other donor sites.…”

Section: A Rational Approach For Treating Ameloblastomamentioning

confidence: 99%

“…9,[15][16][17][19][20][21][22][23][24] Once dehiscence occurs, the vital periosteum accelerates the re-epithelialisation and healing. 16 The muscle-sparing technique diminishes the donor-site dead space and subsequent haematoma, reduces the risk of the pedicle damage, promotes the skin-island pliability, and preserves the donor limb strength. 9 A precondition for the graft curvature, although time-consuming, is frequently coped with the gradual learning curve.…”

Section: A Rational Approach For Treating Ameloblastomamentioning

confidence: 99%

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A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

Chaine¹,

Pitak‐Arnnop²,

Dhanuthai³

et al. 2009

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. FINDINGS:Forty-four ameloblastoma patients were operated during this study period. Sixteen cases had GMA, of which 9 patients were included in this series (mean age: 35 years). The defects in the mandible ranged from 7 to 16 cm in length (mean: 12 cm). The average length of the harvested fibula was 11 cm, and the number of osteotomies ranged from 1 to 2. The mean ischemic time was 137 minutes (range: 90-180 minutes).Neck recipient vessels were used for flap perfusion in all cases. All but one flaps were viable without any complications, whilst partial skin-island necrosis occurred in 2 patients. Hospital stay was 2 weeks in most of the patients. No tumour recurrence was found during the follow-up period (range: 26-73 months). Dental implants were placed in 2 patients. CONCLUSIONS:Despite several limitations of this study, we suggest that a radical approach with the SM-IFFOFR is an effective treatment for GMA. Further well-designed, larger series with longer follow-up periods are still encouraged.

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Section: A Rational Approach For Treating Ameloblastomamentioning

confidence: 99%

Section: A Rational Approach For Treating Ameloblastomamentioning

confidence: 99%

A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

Chaine¹,

Pitak‐Arnnop²,

Dhanuthai³

et al. 2009

European Journal of Surgical Oncology (EJSO)

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“…The survival rate is not influenced by the absence of the medullary circulation when the periosteal blood flow is preserved, the medullary circulation in such a case being re-established through a reversed periosteal blood flow pattern [6,15]. This is the basis of the success of split fibular flaps, where only the periosteal blood supply is preserved [3,4]. Thus, through a transverse osteotomy, preserving the periosteal connection, the fibular shaft is divided and doubled over, either to produce a larger bone diameter, for example, for reconstruction of weight-bearing long bones [4], or to attain a sufficient height in mandibular reconstruction [3].…”

Section: Discussionmentioning

confidence: 99%

“…This is the basis of the success of split fibular flaps, where only the periosteal blood supply is preserved [3,4]. Thus, through a transverse osteotomy, preserving the periosteal connection, the fibular shaft is divided and doubled over, either to produce a larger bone diameter, for example, for reconstruction of weight-bearing long bones [4], or to attain a sufficient height in mandibular reconstruction [3].…”

Section: Discussionmentioning

confidence: 99%

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Krishnan

Müller

2002

Eur Spine J

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IntroductionVarious methods of spinal stabilization, ranging from multiple wire fixation to complex reconstruction with vascularized bone struts, are described in the literature [21]. The choice of method depends on the specific indications posed by the clinical and morpho-physiological situation. Like any surgical method, each spinal fusion technique has its own pitfalls. Graft resorption, collapse, sequestration and pseudarthrosis formation are some of the common complications in using non-vascularized autogenous and allogenous bone grafts, especially in the old and in patients with compromised healing [7,13]. Screw loosening and plate or rod migration are some problems associated with stabilization using implants [7,8]. It has been suggested that vascularized bone flaps do not undergo resorption, and maintain twice the bone density of non-vascularized grafts [28]. The mechanical stability of vascularized bone used in spinal surgery, both initially and in Abstract Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-yearold man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed.

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“…Hence, a fixed prosthesis with contacts relieved during eccentric movements would be a design of choice. The use of double barrel fibula flap and bicortical engagement could be considered which would result in an improved reconstruction of the alveolar process, thus allowing superior individual implant positions and angulations [9,20,21].…”

Section: Analysis Under Vertical and Horizontal Loadingmentioning

confidence: 99%

Comparison of Stresses Around Dental Implants Placed in Normal and Fibula Reconstructed Mandibular Models using Finite Element Analysis

Nesappan

Ariga

2014

JCDR

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Purpose: This study was formulated to evaluate and compare stresses around endosseous implants in various normal and fibula reconstructed mandibular models using finite element analysis method. Materials and Methods:CT scan data of a completely edentulous patient and a fibula reconstructed patient was made and the Dicom images were used to design 3-D mandibular models using software. Based on the information from the scan data, various types of reconstructed FEA models were made. Implants (fixtures) and superstructures were then embedded in each model and Von Mises stress around the neck of each implant under a vertical loading of 200 N and Horizontal load of 50 N was calculated using finite element structural analysis software. The results were compared between the reconstructed mandible and their respective normal mandible. Results:Higher stress values were obtained for all the reconstructed types under horizontal loading and in reconstructed models involving larger area of reconstruction the stress were more. In the models involving smaller area of reconstruction like symphysis alone or body alone there is no significant change in the stress values on vertical loading. Conclusion:Stresses were comparatively smaller in mandibles involving a smaller area of reconstruction. Hence, fixed prosthesis could be advised and a bar retained over denture for reconstruction for larger area of reconstruction.Thiyaneswaran nesappan 1 , padma ariga 2

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Use of the “double barrel” free vascularized fibula in mandibular reconstruction

Cited by 163 publications

References 40 publications

A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

A treatment algorithm for managing giant mandibular ameloblastoma: 5-year experiences in a Paris university hospital

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Comparison of Stresses Around Dental Implants Placed in Normal and Fibula Reconstructed Mandibular Models using Finite Element Analysis

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