Secondary Procedures and Refinements

  • Alessio Baccarani
  • Marta Starnoni
  • Giorgio De SantisEmail author


A number of specific procedures may be applied to improve both functional and aesthetic results in patient undergoing jaws reconstruction with free fibula flap. These procedures should be accounted for since the initial planning and include management of vertical discrepancy, soft tissue management, implant positioning and other minor aesthetic refinements.


Bone revision Free flap and enhancement Lipofilling Soft tissue management 


  1. 1.
    Yim KK, Wei FQ. Fibula osteoseptocutaneous flap for mandible reconstruction. Microsurgery. 1994;15:245, 19949.Google Scholar
  2. 2.
    Wallace CG, Chang YM, Tsai CY, Wei FC. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction. Plast Reconstr Surg. 2010;125:305–14.CrossRefGoogle Scholar
  3. 3.
    Chang YM, Tsai CY, Wei FC. One-stage, double-barrel fibula osteoseptocutaneous flap and immediate dental implants for functional and aesthetic reconstruction of segmental mandibular defects. Plast Reconstr Surg. 2008;122:143–5.CrossRefGoogle Scholar
  4. 4.
    Chang YM, Wallace CG, Tsai CY, Shen YF, Hsu YM, Wei FC. Dental implant outcome after primary implantation into double-barreled fibula osteoseptocutaneous free flap-reconstructed mandible. Plast Reconstr Surg. 2011;128:1220–8.CrossRefGoogle Scholar
  5. 5.
    Iizuka T, Hallermann W, Seto I, Smolka W, Smolka K, Bosshardt DD. Bi-directional distraction osteogenesis of the alveolar bone using an extraosseous device. Clin Oral Implants Res. 2005;16:700–7.CrossRefGoogle Scholar
  6. 6.
    Klesper B, Lazar F, Siessegger M, Hidding J, Zöller JE. Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction: a preliminary study. J Craniomaxillofac Surg. 2002;30:280–5.CrossRefGoogle Scholar
  7. 7.
    Chenping Z, Min R, Liqun X, Yongjie H, Wenjun Y, Tong J, et al. Dental implant distractor combined with free fibular flap: a new design for simultaneous functional mandibular reconstruction. J Oral Maxillofac Surg. 2012;70(11):2687–700.CrossRefGoogle Scholar
  8. 8.
    Lee JH, Kim MJ, Choi WS, Yoon PY, Ahn KM, Myung H, et al. Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap. Int J Oral Maxillofac Surg. 2004;33:150–6.CrossRefGoogle Scholar
  9. 9.
    Li L, Blake F, Heiland M, Schmelzle R, Pohlenz P. Longterm evaluation after mandibular reconstruction with fibular grafts versus microsurgical fibular flaps. J Oral Maxillofac Surg. 2007;65:281–6.CrossRefGoogle Scholar
  10. 10.
    Smolka K, Kraehenbuehl M, Eggensperger N, Hallermann W, Thoren H, Iizuka T, et al. Fibula free flap reconstruction of the mandible in cancer patients: evaluation of a combined surgical and prosthodontic treatment concept. Oral Oncol. 2008;44:571–81.CrossRefGoogle Scholar
  11. 11.
    Chang YM, Wallace CG, Hsu YM, Shen YF, Tsai CY, Wei FC. Outcome of osseointegrated dental implants in double-barrel and vertically distracted fibula osteoseptocutaneous free flaps for segmental mandibular defect reconstruction. Plast Reconstr Surg. 2014;134:1033–43.CrossRefGoogle Scholar
  12. 12.
    Anesi A, Ferretti M, Cavani F, Salvatori R, Bianchi M, Russo A, Chiarini L, Palumbo C. Structural and ultrastructural analyses of bone regeneration in rabbit cranial osteotomy: Piezosurgery versus traditional osteotomes. J Craniomaxillofac Surg. 2018;46(1):107–18. Epub 2017 Oct 12.CrossRefPubMedGoogle Scholar
  13. 13.
    Chiarini L, Albanese M, Anesi A, Galzignato PF, Mortellaro C, Nocini PF, Bertossi D. Surgical Treatment of Unilateral Condylar Hyperplasia With Piezosurgery. J Craniofac Surg. 2014;25(3):808–10.CrossRefGoogle Scholar
  14. 14.
    De Santis G, Pinelli M, Gargano F, Baccarani A. Aesthetic and functional innovations in jaw reconstruction with free fibula flap. In: Eisenmann-Klein M, Neuhann-Lorenz C, editors. Innovations in plastic and aesthetic surgery. Berlin: Springer; 2008.Google Scholar
  15. 15.
    Roumanas ED, Markowitz BL, Lorant JA, Calcaterra TC, Jones NF, Beumer J 3rd. Reconstructed mandibular defects: fibula free flaps and osseointegrated implants. Plast Reconstr Surg. 1997;99:356–65.CrossRefGoogle Scholar
  16. 16.
    Rohner D, Bucher P, Kunz C, Hammer B, Schenk RK, Prein J. Treatment of severe atrophy of the maxilla with the prefabricated free vascularized fibula flap. Clin Oral Implants Res. 2002;13:44–52.CrossRefGoogle Scholar
  17. 17.
    Bertossi D, Bissolotti G, Corrocher G, Anesi A, Nocini PF. O.301 The use of tapered dental implants in severe jaw atrophies. J Craniomaxillofac Surg. 2008;36(Suppl1):S76. Scholar
  18. 18.
    Hakim SG, Kimmerle H, Trenkle T, Sieg P, Jacobsen HC. Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants—19 years of experience with a comprehensive concept. Clin Oral Investig. 2015;19:525–34.CrossRefGoogle Scholar
  19. 19.
    Chang YM, Chan CP, Shen YF, Wei FC. Soft tissue management using palatal mucosa around endosteal implants in vascularized composite grafts in the mandible. Int J Oral Maxillofac Surg. 1999;28:341–3.CrossRefGoogle Scholar
  20. 20.
    Artzi Z, Tai H, Moses O, Kozlovsky A. Mucosal considerations for osseointegrated implants. J Prosthet Dent. 1993;40:427–32.CrossRefGoogle Scholar
  21. 21.
    Bedrossian E, Gongloff RK. Considerations in placement of implants through existing split-thickness skin graft vestibuloplasty. A case report. Int J Oral Maxillofac Implants. 1990;5:401–4.PubMedGoogle Scholar
  22. 22.
    Newman MG, Flemmig TE. Periodontal considerations of implants and implant-associated microbiota. J Dent Educ. 1988;52:737–44.PubMedGoogle Scholar
  23. 23.
    Tsai CY, Ueda M, Hata K-I, Horie K, Hibino Y, Sugimura Y, et al. Clinical results of cultured epithelial cell grafting in the oral and maxillofacial region. J Craniomaxillofac Surg. 1997;25:4–8.CrossRefGoogle Scholar
  24. 24.
    Hayter JP, Cawood JI. Oral rehabilitation with endosteal implants and free flaps. Int J Oral Maxillofac Surg. 1996;25:3–12.CrossRefGoogle Scholar
  25. 25.
    Ten Bruggenkaa CM, K Ler G. Palatal mucosa grafts for dental implant devices. Oral Surg. 1991;72:154–8.CrossRefGoogle Scholar
  26. 26.
    Chiapasco M, Biglioli F, Autelitano L, Romeo E, Brusati R. Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillomandibular defects following ablation for tumors or osteoradionecrosis. Clin Oral Implants Res. 2006;17:220–8.CrossRefGoogle Scholar
  27. 27.
    Kumar VV, Jacob PC, Kekatpure V, Hedne N, Koch FP, Kuriakose MA. The Jugaad technique for jaw reconstruction: denture based inverse planning. J Maxillofac Oral Surg. 2016;15:346–8.CrossRefGoogle Scholar
  28. 28.
    Anesi A, Bissolotti G, Toller N, Corrocher G, Chiarini L, Nocini PF. O.322 Ameloblastic flbroma in a 6-year-old child: case report. J Craniomaxillofac Surg. 2008;36(Suppl1):S81. Scholar
  29. 29.
    Anesi A, Albanese M, Gerosa R, Corrocher G, Gambarini G, Nocini PF. Mandibular ameloblastic fibroma in 6-years-old girl: a case report. Minerva Stomatol. 2008;57(10):549–55. English, Italian.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alessio Baccarani
    • 1
  • Marta Starnoni
    • 1
  • Giorgio De Santis
    • 1
    Email author
  1. 1.Plastic and Reconstructive Surgery UnitUniversity Hospital of ModenaModenaItaly

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