Unicortical Bone Necrosis of the Fibula Free Flap Associated to the Fixation with a Nonlocking 2.0-mm Reconstruction Plate and Screws

Abstract

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

Keywords

bone plates - osteonecrosis - free tissue flaps - reconstructive surgical procedures - postoperative complications

Author Contributions

G.N.P.: Responsible for planning, collecting and interpreting data, writing the manuscript, review of the final version, and answering to the reviewers. D.R.: Responsible for collecting and interpreting data and review of the final version. L.S.: Responsible for collecting and interpreting data and review of the final version. H.F.: Responsible for critical review, important intellectual content, and approval of the final version. A.R.S.: Responsible for critical review and important intellectual content.

Patient Consent

Informed consent was obtained from all individual participants included in the study.

Publikationsverlauf

Artikel online veröffentlicht:
27. Mai 2022

• References

• 1 Hanasono MM, Silva AK, Yu P, Skoracki RJ. A comprehensive algorithm for oncologic maxillary reconstruction. Plastic and Reconstructive Surgery 2013; 131 (Suppl. 01) 47-60
• 2 Katti G, Khan MM, Chaubey SS, Amena M. Cemento-ossifying fibroma of the jaw. BMJ Case Rep 2016; 2016: bcr2015214327
• 3 Peravali RK, Bhat HHK, Reddy S. Maxillo-mandibular cemento-ossifying fibroma: a rare case report. J Maxillofac Oral Surg 2015; 14 (Suppl. 01) 300-307
• 4 Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part II. Technical modifications to maximize aesthetic and functional outcomes. Plastic and Reconstructive Surgery 2012; 129 (Suppl. 01) 139-147
• 5 Al-Bustani S, Austin GK, Ambrose EC, Miller J, Hackman TG, Halvorson EG. Miniplates versus reconstruction bars for oncologic free fibula flap mandible reconstruction. Ann Plast Surg 2016; 77 (03) 314-317
• 6 Shaw RJ, Kanatas AN, Lowe D, Brown JS, Rogers SN, Vaughan ED. Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck 2004; 26 (05) 456-463
• 7 Swendseid B, Kumar A, Sweeny L. et al. Long-term complications of osteocutaneous free flaps in head and neck reconstruction. Otolaryngol Head Neck Surg 2020; 162 (05) 641-648
• 8 Farwell DG, Kezirian EJ, Heydt JL, Yueh B, Futran ND. Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction. Head Neck 2006; 28 (07) 573-579
• 9 López-Arcas JM, Arias J, Del Castillo JL. et al. The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience. J Oral Maxillofac Surg 2010; 68 (10) 2377-2384
• 10 Ansari E, Chargi N, van Gemert JTM. et al. Low skeletal muscle mass is a strong predictive factor for surgical complications and a prognostic factor in oral cancer patients undergoing mandibular reconstruction with a free fibula flap. Oral Oncol 2020; 101: 104530
• 11 Zhang ZL, Wang S, Sun CF, Xu ZF. Miniplates versus reconstruction plates in vascularized osteocutaneous flap reconstruction of the mandible. J Craniofac Surg 2019; 30 (02) e119-e125
• 12 Ehrenfeld M, Manson PN, Prein J. Principles of Internal Fixation of the Craniomaxillofacial Skeleton. AO Foundation. New York, NY: Georg Thieme Verlag; 2012
• 13 Harjani B, Singh RK, Pal US, Singh G. Locking v/s non-locking reconstruction plates in mandibular reconstruction. Natl J Maxillofac Surg 2012; 3 (02) 159-165
• 14 Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck 2000; 22 (01) 17-26
• 15 Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg 2002; 128 (02) 161-166
• 16 Hamscha UM, Weninger WJ, Freystätter C, Tzou CH, Radtke C. Anatomical study of a chimeric fascio-osteomyocutaneous fibula flap for free microvascular tissue transfer. J Reconstr Microsurg 2019; 35 (06) 438-444
• 17 Nakayama B, Matsuura H, Ishihara O, Hasegawa H, Mataga I, Torii S. Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants. Plast Reconstr Surg 1995; 96 (05) 1201-1204
• 18 Triana Jr RJ, Uglesic V, Virag M. et al. Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg 2000; 2 (02) 91-101
• 19 Wei FC, Mardini S. Flaps and Reconstructive Surgery. Edinburg, Scotland: Elsevier; 2009