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J Reconstr Microsurg 2013; 29(07): 427-432
DOI: 10.1055/s-0033-1343953
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Union and Bone Resorption of Free Fibular Flaps in Mandibular Reconstruction

Tuija M. Yla-Kotola
1   Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada
,
Eric Bartlett
2   Department of Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Canada
,
David P. Goldstein
3   Department of Otolaryngology – Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Canada
,
Kathleen Armstrong
1   Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada
,
Ralph W. Gilbert
3   Department of Otolaryngology – Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Canada
,
Stefan O. P. Hofer
1   Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto, Toronto, Canada
› Author Affiliations
Further Information

Publication History

04 October 2012

30 December 2012

Publication Date:
24 April 2013 (online)

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Abstract

Background The purpose of this study was to evaluate bony union and resorption after free fibular flap reconstruction for mandibular reconstruction.

Methods A total of 112 patients with composite resection and reconstruction with a fibular free flap were included. Computed tomography scan images taken after the reconstruction and approximately 1 year postoperatively were assessed to evaluate union (n = 60) and bone resorption (n = 24) of the neomandible.

Results Most of the fibulas healed well (n = 34) and there was radiologic nonunion in 20% of the neomandibles at the time of evaluation (mean = 15 months). There was a statistically significant reduction in bone height in the native mandible (p = 0.02) and the anterior part of the fibular graft (p = 0.02).

Conclusions There was a statistically significant reduction in mandibular and fibular graft height. However, the bone resorption was clinically minimal. Sufficient maintenance of height and good bony union support the use of free fibular flap in mandibular reconstruction.

Keywords

mandible reconstruction - fibula - free flap - bone union - resorption

Note

This study was presented at the Annual Meeting of American Society for Reconstructive Microsurgery in Cancun, Mexico in January, 2011 and at the Congress of the World Society for Reconstructive Microsurgery in Helsinki, Finland in June 2011.


 

  • References

  • 1 Wallace CG, Wei F-C. Mandibular reconstruction. In: Neligan PC, Wei F-C, , eds. Microsurgical Reconstruction of the Head and Neck. St Louis: Quality Medical Publishing; 2010: 701-728
    Google Scholar
  • 2 Cordeiro PG. Frontiers in free flap reconstruction in the head and neck. J Surg Oncol 2008; 97 (8) 669-673
    CrossrefPubMedGoogle Scholar
  • 3 Kim EK, Evangelista M, Evans GR. Use of free tissue transfers in head and neck reconstruction. J Craniofac Surg 2008; 19 (6) 1577-1582
    CrossrefPubMedGoogle Scholar
  • 4 Disa JJ, Hidalgo DA, Cordeiro PG, Winters RM, Thaler H. Evaluation of bone height in osseous free flap mandible reconstruction: an indirect measure of bone mass. Plast Reconstr Surg 1999; 103 (5) 1371-1377
    PubMedGoogle Scholar
  • 5 Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110 (2) 438-449 , discussion 450–451
    CrossrefPubMedGoogle Scholar
  • 6 Hölzle F, Watola A, Kesting MR, Nolte D, Wolff KD. Atrophy of free fibular grafts after mandibular reconstruction. Plast Reconstr Surg 2007; 119 (1) 151-156
    PubMedGoogle Scholar
  • 7 Goh BT, Lee S, Tideman H, Stoelinga PJ. Mandibular reconstruction in adults: a review. Int J Oral Maxillofac Surg 2008; 37 (7) 597-605
    CrossrefPubMedGoogle Scholar
  • 8 Miles BA, Goldstein DP, Gilbert RW, Gullane PJ. Mandible reconstruction. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (4) 317-322
    CrossrefPubMedGoogle Scholar
  • 9 Frodel Jr JL, Funk GF, Capper DT , et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg 1993; 92 (3) 449-455 , discussion 456–458
    CrossrefPubMedGoogle Scholar
  • 10 Huang W-C, Wei F-C. Fibular osseoseptocutaneous flap. In: Neligan PC, Wei F-C, , eds. Microsurgical Reconstruction of the Head and Neck. St Louis: Quality Medical Publishing; 2010: 307-320
    Google Scholar
  • 11 Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 1991; 117 (7) 733-744
    CrossrefPubMedGoogle Scholar
  • 12 Li L, Blake F, Heiland M, Schmelzle R, Pohlenz P. Long-term evaluation after mandibular reconstruction with fibular grafts versus microsurgical fibular flaps. J Oral Maxillofac Surg 2007; 65 (2) 281-286
    CrossrefPubMedGoogle Scholar
  • 13 Wallace CG, Chang YM, Tsai CY, Wei FC. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction. Plast Reconstr Surg 2010; 125 (1) 305-314
    CrossrefPubMedGoogle Scholar
  • 14 Virgin FW, Iseli TA, Iseli CE , et al. Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects. Laryngoscope 2010; 120 (4) 663-667
    CrossrefPubMedGoogle Scholar