Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula

Martin P Huizinga; Martin W Stenekes; Joep Kraeima; Sebastiaan A H J de Visscher; Gerry M Raghoebar; Paul M N Werker; Max J H Witjes

doi:10.1002/hed.27542

Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula

Martin P Huizinga^*, Martin W Stenekes, Joep Kraeima, Sebastiaan A H J de Visscher, Gerry M Raghoebar, Paul M N Werker, Max J H Witjes

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement.

METHODS: The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned.

RESULTS: Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery.

CONCLUSION: The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.

Original language	English
Pages (from-to)	E67-E72
Number of pages	6
Journal	Head & Neck
Volume	45
Issue number	12
Early online date	11-Oct-2023
DOIs	https://doi.org/10.1002/hed.27542
Publication status	Published - Dec-2023

Keywords

fibula fracture
free fibula flap
maxillofacial reconstruction
oral
prefabrication

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@article{3a238bd2b17146a2ae52aae88b80e752,

title = "Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula",

abstract = "BACKGROUND: The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement.METHODS: The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned.RESULTS: Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery.CONCLUSION: The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.",

keywords = "fibula fracture, free fibula flap, maxillofacial reconstruction, oral, prefabrication",

author = "Huizinga, {Martin P} and Stenekes, {Martin W} and Joep Kraeima and {de Visscher}, {Sebastiaan A H J} and Raghoebar, {Gerry M} and Werker, {Paul M N} and Witjes, {Max J H}",

note = "{\textcopyright} 2023 The Authors. Head & Neck published by Wiley Periodicals LLC.",

year = "2023",

month = dec,

doi = "10.1002/hed.27542",

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TY - JOUR

T1 - Prefabricated fibula free flaps in reconstruction of maxillofacial defects

T2 - Two cases of transplanting a fractured fibula

AU - Huizinga, Martin P

AU - Stenekes, Martin W

AU - Kraeima, Joep

AU - de Visscher, Sebastiaan A H J

AU - Raghoebar, Gerry M

AU - Werker, Paul M N

AU - Witjes, Max J H

PY - 2023/12

Y1 - 2023/12

N2 - BACKGROUND: The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement.METHODS: The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned.RESULTS: Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery.CONCLUSION: The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.

AB - BACKGROUND: The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement.METHODS: The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned.RESULTS: Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery.CONCLUSION: The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.

KW - fibula fracture

KW - free fibula flap

KW - maxillofacial reconstruction

KW - oral

KW - prefabrication

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U2 - 10.1002/hed.27542

DO - 10.1002/hed.27542

M3 - Article

C2 - 37818676

SN - 1043-3074

VL - 45

SP - E67-E72

JO - Head & Neck

JF - Head & Neck

IS - 12

ER -

Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula

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