Thirty-eight-year follow-up of the first patient of mandibular reconstruction with free vascularized fibula flap

Background The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction. Case presentation We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

Distal Fibula Reconstruction in Primary Malignant Tumours

(1) Background: Restoration of ankle biomechanics after distal fibula (DF) resection in bone sarcomas can be performed with different techniques. We report the functional and oncological outcomes of a case series; (2) Methods: Ten patients (5 females and 5 males) with a mean age of 27 years (range 10–71) were retrospectively evaluated. Following the resection, different techniques were used to reconstruct the ankle: tibiotalar arthrodesis, residual lateral malleolus fixed to the tibia, non-vascularized or rotational vascularized fibula transposition and intercalary allograft. All complications were recorded, and the functional outcomes were evaluated; (3) Results: The mean follow-up time was 54 months (range, 13–116). Six patients were free of disease while four patients died of disease. All patients had a stable ankle and bone union, which was achieved after a mean of 9.4 months (range 3–20). The mean MSTS Score was 26.7 (range 21–30). Chronic ankle pain and peroneal external nerve palsy were observed. Patients underwent additional surgeries for deep infection and for equinus ankle deformity. No local recurrence was observed. Metastasis occurred in four patients after a mean of 14.7 months (range 2–34); (4) Conclusions: After DF resection, the restoration of ankle biomechanics gives acceptable functional results, but a larger series of patients with long-time follow-up are required to confirm the durability of the reconstruction.

One-stage reconstruction of bone defects with fibula perforator flap

At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.

Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.