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Donor Side Preference in Maxillary Reconstruction With the Free Fibula Flap.

Laurenz Weitgasser1, Richard Barton2, Sophie Ricketts1

  • 1Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Fitzroy.

The Journal of Craniofacial Surgery
|October 6, 2022
PubMed
Summary

Choosing the fibula donor site for maxilla reconstruction impacts outcomes. This study shows ipsilateral fibula flaps are best for ipsilateral vessel anastomosis, while contralateral flaps suit contralateral vessel needs.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic and Reconstructive Surgery
  • Anatomy

Background:

  • Reconstruction of unilateral maxillectomy defects often involves free fibula flaps.
  • The choice of fibula donor side (ipsilateral vs. contralateral) has not been previously detailed in surgical literature.

Purpose of the Study:

  • To analyze anatomical differences between ipsilateral and contralateral free fibula flaps for unilateral maxillectomy reconstruction.
  • To determine the benefits and risks associated with each donor side choice.

Main Methods:

  • Utilized 3D-printed skull models for simulating unilateral maxillectomy reconstruction.
  • Performed fresh cadaveric dissections of both left and right osteomyocutaneous fibula flaps.
  • Conducted detailed photographic documentation to illustrate anatomical variations and pedicle management.

Main Results:

  • The orientation of the skin paddle and flexor hallucis longus muscle is influenced by the donor side selection.
  • The pedicle's planned direction affects the flap's positioning and suitability.
  • Anatomical considerations favor specific donor sites based on the intended recipient vessel anastomosis.

Conclusions:

  • Preferential use of the ipsilateral fibula flap is recommended when anastomosing to ipsilateral facial or neck vessels.
  • Contralateral fibula flap use is advantageous for reconstructions requiring anastomosis to contralateral recipient vessels.