• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.24-28
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• 2004

The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.57-62
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• 2013

Purpose: The aim of this study is to report on the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of large bone and soft tissue defect combined with infection by open tibia fracture. Materials and Methods: During the research period, lasting from December 2002 to June 2008 (Kyung Hee University Medical Center), data were collected from three patients who underwent IVFT after free flap. We analyzed the successiveness and persistency of the infection using free flapping, bone union, and hypertrophy between transposed fibula and tibia. Results: Regarding free flap, successive results were observed in all examples. In the final follow-up results, transposed fibulas all survived, having hypertrophy similar to that of adjacent tibia. Conclusion: Reconstruction of tibia defect with free flap followed by IVTF is a useful and safe method for avoidance of the potential risk of infection for patients with a large tibial bone defect and soft tissue defect associated with infection.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.75-80
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• 2001

Purpose : We have evaluated the morbidity of donor site after transfer of free fibular osseous and osteocutaneous flap to defect site of bone and soft tissue due to chronic osteomyelitis of long tubular bone, open fracture with bony defect, bone or soft tissue tumor and congenital anomaly. Materials and methods : The 54 cases of 79 cases to be carried out from May, 1982 to May, 2001 which could be followed up were reviewed. There were forty nine in male and five in female. The mean age was 35(4 to 66)years old and mean follow up period is 21.3 month(12 to 72). We have retrospectively analyzed the various postoperative complications such as compartment syndrome, donor site infection, skin defect, hypesthesia, hammer toes, ankle instability and activity of daily living by help of questionnaire, telephone, physical examination, follow up x-ray study and chart. Results : In the total 54 cases the medication period for pain control after operation were classified into three groups under 2 weeks(49 cases), from 2 weeks to 6 weeks(3 cases) and over 6 weeks(2 cases). The postoperative morbidity were occurred in total 12 cases(compartment syndrome: 0, infection : 2, skin defect: 1, hypesthesia: 5, hammer toe: 2 ankle pain: 2 discomfort in activity of daily living: 0), and also the morbidity rates of donor site were 23.5% in osseous flap and 21.6% in osteocutaneous flap were occurred. There was no statistical significonce in morbidity between osseous and osteocutaneous free fibular flap transfer(P>0.05). Discussion : In general the morbidity of free fibular flap transfer was relatively high but it did not have any effect on daily activity of living. We think that the meticulous operation technique, detailed wound care and early range of motion exercise will reduce the morbidity of donor site of flap.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.75-79
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• 2000

The foot plays a vital role in standing and gait. This function results from harmonious interaction of bones, joints, and soft tissue. An imbalance or a defect in such structures can lead to impaired function of the foot. The mid foot, composed of cunieforms, navicular and cuboid bone, plays a vital role in maintaining longitudinal and transverse arches and injury or defects to this region can cause instability of the foot. This paper reports a case of complex foot injury; soft tissue defect of dorsum of foot, and medial and intermediate cuneiform bone defect, reconstructed in a single stage using vascularized osteocutaneous fibular free flap. Segmented to fit the defects of medial and intermediate cuneiform bones and a skin paddle providing adequate coverage, restored the stability to the arches and function of the midfoot. The fibula osteocutaneous free flap has appealing characteristics for reconstruction of the foot and the complex mid foot injuries can be considered to the long list of indications.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.4137-4140
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• 2012

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental madibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.68-74
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• 2008

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.190-195
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• 2005

Background and Objectives: Fibula is the flap of choice for reconstruction of wide mandible defects after tumor ablation surgery. In mandible reconstruction, restoring the mandible frame to provide mandibular contour and dental arch while restoring masticatory function are important. Even though vascularized fibula can be osteotomized freely, proper design and flap insetting is not easy because of its three dimensional structure and difference in design according to the defect sites. We reviewed patients who underwent mandible reconstruction with fibular flaps according to the defect sites and suggest proper modification methods of fibular flap according to the various defects sites after tumor ablation surgery. Materials and Methods: Twelve consecutive mandible reconstruction with fibular free flaps were performed for defects after tumor ablation surgery. Patients were classified into 4 groups according to the type of mandibular defect(Group 1 : defect on central segment including symphysis, Group 2 : defect on lateral segment(with or without central segment) confined to body, Group 3 : defect on body and ascending ramus that does not include the condyle, Group 4 : defect including the condyle). Results: We suggest different modification methods of fibular free flap for each patient group. Group 1, 3 ; contour by using multiple closing wedge osteotomy. Group 2 ; single or double barrel reconstruction without wedge osteotomy. Group 4 ; contour using single or multiple wedge osteotomy and condylar reconstruction with costochondral graft. Conclusion: Fibular free flaps can be contoured to any desired shape after multiple osteotomies to restore various mandibular defects. It is a reliable and versatile method for reconstruction of mandibular defects after tumor ablation surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.35.1-35.7
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• 2018

Background: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. Case presentation: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. Conclusions: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.84-90
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• 2021

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5-6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.2
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• pp.138-141
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• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.