Skip to main content

Functional and Aesthetic Reconstruction of Complex Maxillofacial Defects with the Prefabricated Fibula Flap

  • Chapter
  • First Online:
Contemporary Oral Oncology

Abstract

Several organs of multifunctional importance are compactly assembled in the cranio-maxillofacial region. Consequently, cancer resections with adequate safety margins are often significantly debilitating and call for complex primary or secondary reconstructive procedures [1]. Similarly, trauma or atrophy can also originate moderate to severe deficiencies in the hard and soft tissues. Regardless of the aetiology of the defect, the goal is the replacement of the lost hard and soft tissues together with the reestablishment of the patient’s premorbid function and aesthetics. In order to achieve an optimal outcome, a comprehensive multidisciplinary team approach is needed. Indeed, all dimensions and stages of composite cranio-maxillofacial reconstruction require high precision and excellent coordination between the reconstructive surgeon, the prosthodontist and the maxillofacial technician [1–4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Change history

References

  1. 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.

    Article  CAS  Google Scholar 

  2. Roser SM, Ramachandra S, Blair H, Grist W, Carlson GW, Christensen AM, et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg. 2010;68:2824–32.

    Article  Google Scholar 

  3. Eckardt A, Swennen GR. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg. 2005;16:1137–40.

    Article  Google Scholar 

  4. Beumer J, Marunick MT, Garrett N, Rohner D, Reintsema H, Abemayor E, et al. Rehabilitation of maxillary defects. In: Beumer J, Marunick MT, Esposito SJ, editors. Maxillofacial rehabilitation: prosthodontic and surgical management of cancer-related, acquired, and congenital defects of the head and neck. 3rd ed. Illinois: Quintessence; 2011. p. 155–212.

    Google Scholar 

  5. Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, Levine JP. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction. J Oral Maxillofac Surg. 2009;67:2115–22.

    Article  Google Scholar 

  6. Rohner D, Kunz C, Bucher P, Hammer B, Prein J. New possibilities for reconstructing extensive jaw defects with prefabricated microvascular fibula transplants and ITI implants. Mund Kiefer Gesichtschir. 2000;4:365–72.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Rohner D, Jaquiery C, Kunz C, Bucher P, Maas H, Hammer B. Maxillofacial reconstruction with prefabricated osseous free flaps: a 3-year experience with 24 patients. Plast Reconstr Surg. 2003;112:748–57.

    Article  Google Scholar 

  9. Jaquiery C, Rohner D, Kunz C, Bucher P, Peters F, Schenk RK, et al. Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants – a prospective study. Clin Oral Implants Res. 2004;15:598–606.

    Article  Google Scholar 

  10. Pogrel MA, Podlesh S, Anthony JP, Alexander J. A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg. 1997;55:1200–6.

    Article  CAS  Google Scholar 

  11. David DJ, Tan E, Katsaros J, Sheen R. Mandibular reconstruction with vascularized iliac crest: a 10-year experience. Plast Reconstr Surg. 1988;82:792–803.

    Article  CAS  Google Scholar 

  12. Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg. 1999;104:1314–20.

    Article  CAS  Google Scholar 

  13. Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84:71–9.

    Article  CAS  Google Scholar 

  14. Yim KK, Wei FC. Fibula osteoseptocutaneous flap for mandible reconstruction. Microsurgery. 1994;15:245–9.

    Article  CAS  Google Scholar 

  15. Yim KK, Wei FC. Fibula osteoseptocutaneous free flap in maxillary reconstruction. Microsurgery. 1994;15:353–7.

    Article  CAS  Google Scholar 

  16. Forrest C, Boyd B, Manktelow R, Zuker R, Bowen V. The free vascularised iliac crest tissue transfer: donor site complications associated with eighty-two cases. Br J Plast Surg. 1992;45:89–93.

    Article  CAS  Google Scholar 

  17. Hidalgo DA, Rekow A. A review of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg. 1995;96:585–96; discussion 597–602.

    Article  CAS  Google Scholar 

  18. Nakayama B, Matsuura H, Hasegawa Y, Ishihara O, Hasegawa H, Torii S. New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap. Br J Plast Surg. 1994;47:247–9.

    Article  CAS  Google Scholar 

  19. Reychler H, Iriarte Ortabe J. Mandibular reconstruction with the free fibula osteocutaneous flap. Int J Oral Maxillofac Surg. 1994;23:209–13.

    Article  CAS  Google Scholar 

  20. Shpitzer T, Neligan PC, Gullane PJ, Boyd BJ, Gur E, Rotstein LE, et al. The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation. Head Neck. 1999;21:639–47.

    Article  CAS  Google Scholar 

  21. Thoma A, Archibald S, Payk I, Young JE. The free medial scapular osteofasciocutaneous flap for head and neck reconstruction. Br J Plast Surg. 1991;44:477–82.

    Article  CAS  Google Scholar 

  22. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55:533–44.

    Article  CAS  Google Scholar 

  23. Vinzenz KG, Holle J, Wuringer E, Kulenkampff KJ. Prefabrication of combined scapula flaps for microsurgical reconstruction in oro-maxillofacial defects: a new method. J Craniomaxillofac Surg. 1996;24:214–23.

    Article  CAS  Google Scholar 

  24. Chang YM, Santamaria E, Wei FC, Chen HC, Chan CP, Shen YF, et al. Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction. Plast Reconstr Surg. 1998;102:680–8.

    Article  CAS  Google Scholar 

  25. Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994;93:294–304; discussion 305–296.

    Article  CAS  Google Scholar 

  26. Nazerani S, Behnia H, Motamedi MH. Experience with the prefabricated free fibula flap for reconstruction of maxillary and mandibular defects. J Oral Maxillofac Surg. 2008;66:260–4.

    Article  Google Scholar 

  27. 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 maxillo-mandibular defects following ablation for tumors or osteoradionecrosis. Clin Oral Implants Res. 2006;17:220–8.

    Article  Google Scholar 

  28. Vinzenz KG, Holle J, Wuringer E, Kulenkampff KJ, Plenk Jr H. Revascularized composite grafts with inserted implants for reconstructing the maxilla – improved flap design and flap prefabrication. Br J Oral Maxillofac Surg. 1998;36:346–52.

    Article  CAS  Google Scholar 

  29. Jones NF, Swartz WM, Mears DC, Jupiter JB, Grossman A. The “double barrel” free vascularized fibular bone graft. Plast Reconstr Surg. 1988;81:378–85.

    Article  CAS  Google Scholar 

  30. Bahr W, Stoll P, Wachter R. Use of the “double barrel” free vascularized fibula in mandibular reconstruction. Op Tech Otolaryngol Head Neck. 1998;56:38–44.

    CAS  Google Scholar 

  31. 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.

    Article  CAS  Google Scholar 

  32. Warrer K, Buser D, Lang NP, Karring T. Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res. 1995;6:131–8.

    Article  CAS  Google Scholar 

  33. Rohner D, Bucher P, Hammer B. Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique and long term experience. Oral Craniofac Tissue Eng. 2011;1:11–9.

    Google Scholar 

  34. Rohner D, Martínez RG, Bucher P, Hammer B. Importance of patient-specific intraoperative guides in complex maxillofacial reconstruction. Journal of CranioMaxillofacial Surgery. 2013; 41(5):382–90. https://doi.org/10.1016/j.jcms.2012.10.021.

Download references

The contents in this chapter is based on the previous published work “Importance of patient specific intraoperative guides in complex maxillofacial reconstruction” published in the Journal of Cranio-Maxillofacial Surgery, Elsevier 2013.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dennis Rohner MD, DDS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Rohner, D., Guijarro-Martínez, R., Bucher, P., Hammer, B. (2017). Functional and Aesthetic Reconstruction of Complex Maxillofacial Defects with the Prefabricated Fibula Flap. In: Kuriakose, M.A. (eds) Contemporary Oral Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-43854-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43854-2_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43852-8

  • Online ISBN: 978-3-319-43854-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics