Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications

The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside) oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.

Keywords

Mandibular reconstruction - Fibula - Microsurgery

Publikationsverlauf

Eingereicht: 20. November 2015

Angenommen: 31. Dezember 2015

Artikel online veröffentlicht:
20. April 2022

• References

• 1 Erdmann D, Giessler GA, Bergquist GE. et al. Free fibula transfer: analysis of 76 consecutive microsurgical procedures and review of the literature. Chirurg 2004; 75: 799-809
• 2 Wallace CG, Chang YM, Tsai CY. et al. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction. Plast Reconstr Surg 2010; 125: 305-314
• 3 Foster RD, Anthony JP, Sharma A. et al. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck 1999; 21: 66-71
• 4 Pogrel MA, Podlesh S, Anthony JP. et al. A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg 1997; 55: 1200-1206
• 5 Chim H, Salgado CJ, Mardini S. et al. Reconstruction of mandibular defects. Semin Plast Surg 2010; 24: 188-197
• 6 King TW, Gallas MT, Robb GL. et al. Aesthetic and functional outcomes using osseous or soft-tissue free flaps. J Reconstr Microsurg 2002; 18: 365-371
• 7 Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg 1979; 64: 595-604
• 8 Soutar DS, Scheker LR, Tanner NS. et al. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36: 1-8
• 9 Swartz WM, Banis JC, Newton ED. et al. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg 1986; 77: 530-545
• 10 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55: 533-544
• 11 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84: 71-79
• 12 Chen ZW, Yan W. The study and clinical application of the osteocutaneous flap of fibula. Microsurgery 1983; 4: 11-16
• 13 Daya M. Peroneal artery perforator chimeric flap: changing the perspective in free fibula flap use in complex oromandibular reconstruction. J Reconstr Microsurg 2008; 24: 413-418
• 14 Cheng MH, Saint-Cyr M, Ali RS. et al. Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defects. Head Neck 2009; 31: 361-370
• 15 Heitmann C, Khan FN, Levin LS. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 2003; 19: 157-162
• 16 Potter JK, Lee MR, Oxford L. et al. Proximal peroneal perforator in dual-skin paddle configuration of fibula free flap for composite oral reconstruction. Plast Reconstr Surg 2014; 133: 1485-1492
• 17 Hayden RE, Mullin DP, Patel AK. Reconstruction of the segmental mandibular defect: current state of the art. Curr Opin Otolaryngol Head Neck Surg 2012; 20: 231-236
• 18 Leclere FM, Bosc R, Temam S. et al. Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures. Laryngoscope 2014; 124: 1336-1343
• 19 Nakajima H, Fujino T, Adachi S. A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization. Ann Plast Surg 1986; 16: 1-19
• 20 Horiuchi K, Hattori A, Inada I. et al. Mandibular reconstruction using the double barrel fibular graft. Microsurgery 1995; 16: 450-454
• 21 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: 143-145
• 22 He Y, Zhang ZY, Zhu HG. et al. Double-barrel fibula vascularized free flap with dental rehabilitation for mandibular reconstruction. J Oral Maxillofac Surg 2011; 69: 2663-2669
• 23 Chang YM, Wallace CG, Hsu YM. et al. 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: 1033-1043
• 24 Shen Y, Guo XH, Sun J. et al. Double-barrel vascularised fibula graft in mandibular reconstruction: a 10-year experience with an algorithm. J Plast Reconstr Aesthet Surg 2013; 66: 364-371
• 25 Strackee SD, Kroon FH, Jaspers JE. et al. Modeling a fibula transplant in mandibular reconstructions: evaluation of the effects of a minimal number of osteotomies on the contour of the jaw. Plast Reconstr Surg 2001; 108: 1915-1921
• 26 Marchetti C, Bianchi A, Mazzoni S. et al. Oromandibular reconstruction using a fibula osteocutaneous free flap: four different "preplating" techniques. Plast Reconstr Surg 2006; 118: 643-651
• 27 Pellini R, Mercante G, Spriano G. Step-by-step mandibular reconstruction with free fibula flap modelling. Acta Otorhinolaryngol Ital 2012; 32: 405-409
• 28 Yeung RW, Samman N, Cheung LK. et al. Stereomodel-assisted fibula flap harvest and mandibular reconstruction. J Oral Maxillofac Surg 2007; 65: 1128-1134
• 29 Hirsch DL, Garfein ES, Christensen AM. et al. 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: 2115-2122
• 30 Succo G, Berrone M, Battiston B. et al. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning. Eur Arch Otorhinolaryngol 2015; 272: 1491-1501
• 31 Moro A, Cannas R, Boniello R. et al. Techniques on modeling the vascularized free fibula flap in mandibular reconstruction. J Craniofac Surg 2009; 20: 1571-1573
• 32 Ling XF, Peng X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg 2012; 129: 657-674
• 33 Seto I, Marukawa E, Asahina I. Mandibular reconstruction using a combination graft of rhBMP-2 with bone marrow cells expanded in vitro. Plast Reconstr Surg 2006; 117: 902-908
• 34 Matsuo A, Chiba H, Takahashi H. et al. Bone quality of mandibles reconstructed with particulate cellular bone and marrow, and platelet-rich plasma. J Craniomaxillofac Surg 2011; 39: 628-632
• 35 Herford AS, Boyne PJ. Reconstruction of mandibular continuity defects with bone morphogenetic protein-2 (rhBMP-2). J Oral Maxillofac Surg 2008; 66: 616-624
• 36 Carter TG, Brar PS, Tolas A. et al. Off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for reconstruction of mandibular bone defects in humans. J Oral Maxillofac Surg 2008; 66: 1417-1425
• 37 van Gemert JT, van Es RJ, Van Cann EM. et al. Nonvascularized bone grafts for segmental reconstruction of the mandible: a reappraisal. J Oral Maxillofac Surg 2009; 67: 1446-1452
• 38 Gadre PK, Ramanojam S, Patankar A. et al. Nonvascularized bone grafting for mandibular reconstruction: myth or reality?. J Craniofac Surg 2011; 22: 1727-1735
• 39 Hanasono MM, Zevallos JP, Skoracki RJ. et al. A prospective analysis of bony versus soft-tissue reconstruction for posterior mandibular defects. Plast Reconstr Surg 2010; 125: 1413-1421
• 40 Mosahebi A, Chaudhry A, McCarthy CM. et al. Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer. Plast Reconstr Surg 2009; 124: 1571-1577
• 41 Wei FC, Seah CS, Tsai YC. et al. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg 1994; 93: 294-304
• 42 Minami A, Usui M, Ogino T. et al. Simultaneous reconstruction of bone and skin defects by free fibular graft with a skin flap. Microsurgery 1986; 7: 38-45
• 43 van Twisk R, Pavlov PW, Sonneveld J. Reconstruction of bone and soft tissue defects with free fibula transfer. Ann Plast Surg 1988; 21: 555-558
• 44 Loeffelbein DJ, Holzle F, Wolff KD. Double-skin paddle perforator flap from the lateral lower leg for reconstruction of through-and-through cheek defect: a report of two cases. Int J Oral Maxillofac Surg 2006; 35: 1016-1020
• 45 Rosenberg AJ, Van Cann EM, van der Bilt A. et al. A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 2009; 38: 666-670
• 46 Guillemaud JP, Seikaly H, Cote D. et al. The implantable Cook-Swartz Doppler probe for postoperative monitoring in head and neck free flap reconstruction. Arch Otolaryngol Head Neck Surg 2008; 134: 729-734
• 47 Kind GM, Buntic RF, Buncke GM. et al. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 1998; 101: 1268-1273
• 48 Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110: 438-449
• 49 Anthony JP, Rawnsley JD, Benhaim P. et al. Donor leg morbidity and function after fibula free flap mandible reconstruction. Plast Reconstr Surg 1995; 96: 146-152
• 50 Bodde EW, de Visser E, Duysens JE. et al. Donor-site morbidity after free vascularized autogenous fibular transfer: subjective and quantitative analyses. Plast Reconstr Surg 2003; 111: 2237-2242
• 51 Levine JP, Bae JS, Soares M. et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg 2013; 131: 1386-1391
• 52 Wang WH, Zhu J, Deng JY. et al. Three-dimensional virtual technology in reconstruction of mandibular defect including condyle using double-barrel vascularized fibula flap. J Craniomaxillofac Surg 2013; 41: 417-422