Intraoperative planning and inset principles of fibula osteoseptocutaneous flap in compound or composite oromandibular defect reconstruction

Year 2006, Volume: 16 Issue: 4, 145 - 154, 27.08.2006

Betül Gözel Ulusal Ali Engin Ulusal Ming Huei Cheng Fun Chan Weı

Abstract

Objectives: The use of free fibular osteocutaneous flap was evaluated in the reconstruction of com­ pound and composite mandibular defects.Patients and Methods: The study included 30 patients 27 males, 3 females, mean age 52.6 years; range 42 to 66 years who received free osteoseptocutaneous fibular flap for the reconstruction of compound or com­ posite oromandibular defects following surgical tumor ablation. Five patients with extensive skin defects accompanying lateral mandible and oral defects also received free anterolateral thigh perforator flap. Other patients were treated with conventional fibular osteocu­ taneous flap or its chimeric form. The mean follow-up period was 19.4 months range 8 to 38 months .Results: With the applied technique, a successful functional and aesthetic restoration was achieved with- out total flap failure and with minimal donor site morbidity. Infection and fascial abscess encountered in one patient were treated with debridement and antibi- otictherapy. İn one patient who developed osteonecro- sis in the neomandibula, the plate was removed and debridement was performed in the 13th month.Conclusion: By appropriate flap planning and placement, reconstruction of large oromandibular tumors with osteocutaneous fibular flaps provides successful functional and aesthetic restoration.

Keywords

Fibula/transplantation, mandible/surgery, sur­gical flaps/methods

Birleşik ya da kompozit oromandibüler defektlerin fibula osteoseptokutanöz fleple rekonstrüksiyonunda intraoperatif planlama ve flep yerleştirme prensipleri

Abstract

Amaç: Birleşik ve kompozit mandibula defektlerininrekonstrüksiyonunda serbest fibula osteoseptokutanöz flebin kullanımı değerlendirildi.Hastalar ve Yöntemler: Cerrahi tümör ablasyonusonrasında birleşik ve kompozit oromandibüler defektler için serbest fibula osteoseptokutanöz flep kullanılan 30 hasta incelendi. Lateral mandibula ve oral defekte geniş cilt eksizyonunun eşlik ettiği olgularda n=5 ikinci bir flep olarak serbest anterolateral uylukperforatör flep uygulandı. Diğer olgularda konvansiyonel serbest fibula osteoseptokutanöz flep ya dakaymerik flep formu kullanıldı. Ortalama izlem süresi 19.4 aydı dağılım 8-38 ay .Bulgular: Uygulanan teknikle izlem süresi içindetotal flep kaybı görülmedi ve başarılı estetik vefonksiyonel restorasyon elde edildi. Donör alanmorbiditesi minimaldi. Bir olguda gelişen enfeksiyon ve fasiyal apse debridman ve antibiyotik tedavisi ile düzeldi. Bir olguda neomandibulada osteonekroz görülmesi üzerine 13. ayda plak çıkarıldıve debridman yapıldı.Sonuç: Geniş oromandibüler tümörlerin osteokutanöz fibula flebiyle rekonstrüksiyonunda doğru bir flepplanlaması ve yerleştirilmesiyle başarılı bir fonksiyonel ve estetik restorasyon sağlanabilir

Keywords

Fibula/transplantasyon, mandibula/ cerrahi, cerrahi flep/yöntem.

References

• Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteoseptocutaneous flap for reconstruction of com- posite mandibular defects. Plast Reconstr Surg 1994;93:294-304; discussion 305-6.
• Yim KK, Wei FC. Fibula osteoseptocutaneous flap for mandible reconstruction. Microsurgery 1994;15:245-9.
• Şengezer M, Türegün M, Işık S, Demiroğulları M. Serbest fibula flebi ile mandibula onarımı. Türk Plast Cer Derg 1997;5:7-13.
• Güçer T, Coşkunfırat K, Çilingir M, Markal N, Türkgüven Y. Serbest fibula flebi ile mandibula defek- tlerinin onarımı. Türk Plast Cer Derg 1996;4:16-20.
• Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HF. Geometry of the vascular pedicle in free tis- sue transfers to the head and neck. Arch Otolaryngol Head Neck Surg 1989;115:954-60.
• Wenig BL, Keller AJ. Microvascular free flap recon- struction for head and neck defects. Arch Otolaryngol Head Neck Surg 1989;115:1118-20.
• Wei FC, Chen HC, Chuang CC, Noordhoff MS. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 1986;78:191-200.
• 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.
• Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84:71-9.
• Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg 2003;30:473-80.
• Celik N, Wei FC. Technical tips in perforator flap har- vest. Clin Plast Surg 2003;30:469-72.
• Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T. Free combined anterolateral thigh flap and vascularized fibula for wide, through-and- through oromandibular defects. J Reconstr Microsurg 1998;14:529-34.
• Bianchi B, Ferrari S, Poli T, Bertolini F, Raho T, Sesenna E. Oromandibular reconstruction with simultaneous free flaps: experience on 10 cases. Acta Otorhinolaryngol Ital 2003;23:281-90.
• Gabr EM, Kobayashi MR, Salibian AH, Armstrong WB, Sundine M, Calvert JW, et al. Oromandibular reconstruction with vascularized free flaps: a review of 50 cases. Microsurgery 2004;24:374-7.
• Anthony JP, Ritter EF, Young DM, Singer MI. Enhancing fibula free flap skin island reliability and versatility for mandibular reconstruction. Ann Plast Surg 1993;31:106-11.
• Graham RG, Swan MC, Hudson DA, van Zyl JE. The fibula free flap: advantages of the muscle sparing tech- nique. Br J Plast Surg 2003;56:388-94.
• Jones NF, Vogelin E, Markowitz BL, Watson JP. Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap. Plast Reconstr Surg 2003;112:758-65.
• Wei FC, Celik N. Perforator flap entity. Clin Plast Surg 2003;30:325-9.
• Huang WC, Chen HC, Wei FC, Cheng MH, Schnur DP. Chimeric flap in clinical use. Clin Plast Surg 2003;30:457-67.
• Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP, Kroll SS, et al. Influence of prior radiothera- py on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326-30.
• Wei FC, Celik N, Chen HC, Cheng MH, Huang WC. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 2002;109:45-52.
• Lin CT, Leung JK, Chen JS, Yang KC. Combined free fibular osteocutaneous-lateral calcaneal fasciocuta- neous flap for reconstruction of composite oro- mandibular defects. Ann Plast Surg 2004;53:442-8.
• Chen HC, Demirkan F, Wei FC, Cheng SL, Cheng MH, Chen IH. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 1999;103:839-45.