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Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.
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Humans , Dental Implants , Plastic Surgery Procedures , Free Tissue Flaps/surgery , Quality of Life , Dental Implantation, Endosseous , Fibula/surgery , Bone Transplantation , Mandibular ReconstructionABSTRACT
Free vascularised fibular flap has many advantages in repair of mandibular defects, and it has become the main method in the mandibular reconstruction. However, the traditional free fibular flap used to repair the mandibular defect is lack of individualised design and precise surgical guidance, and it is difficult to achieve accurate repair and the effect of reconstruction. The concept of personalised and accurate functional reconstruction and the clinically application of digital medical technology provides a new approach to solve the problems. The application of digital medical technology in the repair of mandibular defects with fibular flap is one of the hotspots of current research. This article introduces the application characteristics of digital medical technology, such as 3-dimensional reconstruction technology, virtual surgery planning (VSP) technology and 3D printing technology, in the repair of mandibular defects with fibular flap transfer.
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Background: The free vascularized fibula has become the first choice of vascularised bone transfer. The advantages of fibula over other microvascular flaps include greater bone length, sufficient pedicle length and size, rich periosteal blood supply, etc.Aim: This study was designed to evaluate the long-term donor site morbidity following microvascular fibula transfer.Methods: This study was conducted over two years, in patients who underwent free fibula flap for various defects which needed a composite osseo-fasciocutaneous flap. They were followed up for one year and the donor site evaluated for complications like edema, pain, anaesthesia, spasm of muscles, Flexor hallucis longus (FHL) contracture, ankle stability and hypertrophic scarring.Results: 28 patients, age ranging 15 to 56 years, of which 22 were male and 6 were female. Total of 7 patients (25%) had complications, of which 6 patients had more than one complication. No patients experienced knee instability, weakness, or decreased range of motion. All patients returned to their normal ambulatory status.Conclusion: Free fibula transfer does have long term donor site complications, but they can be managed conservatively, seldom requiring surgical intervention. However, there are no functional limitations which makes it a feasible option in reconstructing a composite defect.in various literatures.
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To summarize the application of enhanced recovery after surgery (ERAS) principles in treating long bone defect with free fibula graft (FVFG). Methods From January, 2012 to January, 2017, ERAS principles were applied in 26 cases of long bone defect treating with vascularized fibula flap graft, via a series of com-prehensive measures, including strengthening psychological nursing, nutrition support and pain management, optimiz-ing operation plan, and early scientific functional exercise. Surgical duration, hospital stay time, satisfaction of pa-tients, postoperative visual analogue scale (VAS) score, bone defect healing time, and Enneking score were recorded through regular outpatient follow-up after discharge. Results The average length of surgical duration and hospital stay time was(3.2±0.5) h and (10.2±1.2) d, respectively. Discharged satisfaction was greater than 95%. Postoperative VAS score was less than 3. During the follow-up period of 1.6-6.0 years, 26 fibular flap survived, and all the bone defect were healed, with an average healing time of (5.5±0.6) months.Followed-up at 1.5 years after the operation, the upper limb function of 7 patients increased by 80.1%, and the lower limb function of 19 patients increased by 82.5%. Conclusion The application of ERAS in treating long bone defect with FVFG can obtain satisfactory limb function, alleviate patients’pain, shorten the duration of hospitalization, promote the rehabilitation and satisfaction of patients.
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Objective@#To discuss the key points of implant restoration on folded fibular graft for mandibular defect.@*Methods@#Fifteen patients with mandibular ameloblastoma were treated by segmental resection of the mandible.The mandibular defect was reconstructed with vascularized folded fibular graft. Implant restoration on the graft was conduced 6-9 months after operation.The results were evaluated.@*Results@#All patients had no tenderness in the temporomandibular joint region. The mouth opening reached 3.1-3.9 cm and the occlusion relationship was good. There was no obvious abnormality in masticatory and swallowing function. After 12-48 months of follow-up, the implants were all survived.@*Conclusions@#The application of folded fibula for both mandible defect repair and postoperative implant restoration could achieve satisfactory results in restoration of the facial appearance and physiological function of oral cavity.
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Objective@#To evaluate the quality of life (QOL) of patients who underwent resection of mandible and reconstruction by fibula flap.@*Methods@#A total of seventy six patients who underwent resection of mandible and reconstruction by fibula flap admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2016 were prospectively analyzed. In the preoperative and postoperative 3 month, 12 months, the QOL of these patients were assessed by using the 14-item oral health impact profile questionnaires (OHIP), The University of Washington quality of life (UW-QOL) and the European organization for research and treatment of cancer quality of life questionnaire head and neck module (EORTC-QLQ-H&N).@*Results@#The OHIP-14 questionnaire showed the highest score of the three months after surgery was mental discomfort (73.0±11.9) and psychological disorder (72.1±11.9), and it was difficult to be relieved over time. In the 12 months after surgery, the lowest scores were physiological pain (35.0±8.6) and disability (37.5±10.2), and 87% (66/76) patients thought that the flap repair worked well. The UW-QOL questionnaire showed that the scores of the patients' chewing, taste and salivary were significantly reduced by 3 months after the operation, and they were still unable to recover to preoperative level 12 months after surgery. The EORTC-QLQ-H&N35 questionnaire showed that swallowing, language, and diet scored higher in the three months after surgery, but could be restored to preoperative levels 12 months after surgery. The score was higher in 12 months after the operation than before surgery and was related to radiotherapy in some patients.@*Conclusions@#Using fibula flap to repair the mandible defect can restore the patient's jaw function and improve the quality of life of the patients.
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BACKGROUND: The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. CASE PRESENTATION: For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. CONCLUSIONS: Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.
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Humans , Alveolar Process , Carcinoma, Squamous Cell , Dental Implants , Fibula , Mandible , Mandibular Reconstruction , Osteogenesis, Distraction , RehabilitationABSTRACT
Objective To discuss the clinical effect of Da Vinci robot-assisted free fibula flap for the management of mandibular and mouth segmental defect.Methods There was a patient with malignant neoplasm of lower gum,which underwent robot-assisted free fibula flap for the management of mandibular and mouth segmental defect,was analyzed.The surgery was divided into two groups:a group resected the primary tumors,another group cut fibula free flap.Use of Da Vinci robotic surgical system for vascular anastomosis and suture of the oral mucosa.Results Four weeks after surgery,the free fibula flap survived completely.There was no infection in the mouth.The patient can walk freely and eating semifluid.Conclusion The Da Vinci robotic surgical system is a stable,minimally invasive,clear and safe method for microsurgery.
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Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.
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BACKGROUND: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. METHODS: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. RESULTS: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. CONCLUSIONS: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.
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Fibula , Mandible , Mandibular Reconstruction , Methods , Surgery, Computer-Assisted , TransplantsABSTRACT
Objective To investigate the application of vascularized free fibula flaps in reconstruction of mandibular defect,and to evaluate the survival rate and repair effect of the method.Methods 16 patients with mandibular tumor,having a desire to reconstruct mandible,and their systemic state could tolerate the long time operation, were selected to reconstruct mandibular defect by vascularized fibula flaps,of which 12 were male,4 female,aged 24-66 years old,average 45.2 years old.The resection of primary tumor and free fibula flaps were simultaneously conducted,then the fibular flaps were shaped according to the defect location and size of the mandible,and were fixed with reconstructive titanium plate for repair and reconstruction of mandible. The survival of flaps was determined by skin color, texture, and skin temperature of the flaps. The reconstruction effects were evaluated through the patients’surface like photos and X-ray picture of mandible before and after operation.Results All of flaps were survived and no serious complications were found. The complications of the supplied sites were skin tension and wound dehiscence, which were healed by dressing. The mandibular reconstruction effects were good through 2 or more persons’double blind evaluation.Conclusion Free fibula flaps have high survival rate and good results in mandibular reconstruction,and they can meet the needs of various types of mandibular defect repair.
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Objective To investigate the effect of free transplantation of fibula composite tissue flap to the repair of forearm bone and soft tissue serious defect.Methods Eleven cases of reparing forearm bone and soft tissue serious defect through transplantation of free fibula composite tissue petal were applied from March 2004 to February 2011.The length of transplanted fibula composite tissue flap was 8-14 cm ; the flap area was 5 cm ×8 cm-20 cm ×20 cm.The curing situation on bone fracture was observed in 3,6 and 12 months after the surgical opration and the function of defected arm was evaluated in 1 year after surgical operation.Results All of 11 cases of fibula composite tissue flap were survived.The observation was undertaken for more than 12 months after the operation and the fracture section occured the characteristics of healing up in 3 months and fibula and arm bone occured well healed up in half a year; It scored 22.9 according to Enneking system after 1 year of the operation.The function of forearm rotation were classed as this:3 good cases,6 medium cases and 2 poor cases.In the 2 sural nerve bridging transplantation cases,one case was repaired of radial nerve inside static's two-point discrimination (s2PD) to 9 mm,another case was repaired of ulnar nerve distal volar little finger s2PD to 15 mm.All the cases could achieve making a fist with thumb and a thumb could be oppoiste to other 4 fingers,and the ankle joint movement was normal.Conclusion Transplantion of free fibula composite tissue flap to the repair of forearm bone and soft tissue serious defect is an ideal surgical operation method.
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Objective To investigate the effect of vascularized fibula with fibular flap to repair limb bones and soft tissue defects.Methods Transpositional fibulas were used to repair tibiae defects in 4 cases.Free fibular transplantation was used in 6 cases,including folded fibular transplantation in 3 cases distal femur repair in 2 cases,calcaneus repair in I case.Hole fibular transplantation was used in 11 cases to repair tibia radius and metatarsal bones.Semi-fibular transplantation was used to repair metacarpal bone defects in 2 cases.All transplanted bones were together with the flap to repair bones and soft tissue defects.Results Twenty cases were all survived,with bone healing time of 6 to 10 weeks,and weight bearing time of 3 to 6 months,fifteen cases were followed up for 6 months to 4 years,and the results showed that their transplanted bones became thicker,their lower limbs recovered to normal walking,hand grip function recovered,the transplanted flaps were elastic.Conclusion Vascularized fibula and fibular flaps transplantation was an effective way to repair limb bones and soft tissue defects.
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6 cases(2 males to 4 females) who have received mandibula reconstruction with free vascularized fibular flaps in our hospital were studied retrospectively.The average length of the fibula grafts was 8.0 cm(range from 7.0 to 14 cm). 3 cases received primary insertion of osteointegrated dental implants into the free fibula flap. The mean follow-up of six cases of patients was 3 months to 1 year. The success rate was 100%. All patients spoke clearly. 4 patients could eat normally, the other two could eat soft food. 5/6 of patients with the recovery of facial appearance was satisfied. All patients were able to walk normally. No ankle unstability was reported. Vascularized free fibula flap is confirmed to be one of the optimal methods for mandible reconstruction by our study.
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ve method of limb salvage.
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Objective:This article discusses a saved-time and strength method with the vascularized fibula free combined flap for instant mandible retained condyle and corresponding soft tissue reconstruction.This method is based on our clinical experience.Methods: 8 patients suffering from combined mandibular defect because of series of reasons were chosen.Combined vascularized fibula free flap for instant mandible retained condyle and corresponding soft tissue reconstruction was performed.The skin paddle(skin island) of the osteocutanous flap was based on the perforators and used to repair mucosal or skin defect,or as an external"monitor",which was shuttle-shaped.The average value of the fibula length is 8.5cm and the average value of surface area of skin paddle(skin island) is 6.5cm?3.5cm.The fibulas were shaped and fixed with long prefabricated titanium plate on 3 patients and with segmented mini-plate/16-holed titanium plate on the rest patients.Results: All flaps survived well without failure except one.All patients had well-incisions,good occlusion,mandibular normal activity and symmetric appearance.But the lasting time of using long prefabricated titanium plate is longer than that of using segmented mini-plate/16-holed titanium plate.Conclusions:Combined vascularized fibula free flap can cut into 2~3 segments based on the mandibular shape and occlusion,shaping and fixation using segmented mini-plate/16-holed titanium plate make the procedure easier and safer.It is advised that the fixation sequence is firstly condyle,secondly the angle and next the mental foreman area and the connection between the fibula and the chin.