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Maxillary Reconstruction with Free Vascularized Fibula: 15-Year Experience
Min-Jeong Cho1, Pablo L Padilla2, Roman J Skoracki1
1From the Department of Plastic and Reconstructive Surgery, Ohio State University.
Plastic and Reconstructive Surgery
|August 30, 2024
Summary
Free fibula flaps offer reliable midface reconstruction after maxillectomy, restoring dental function, orbital support, and facial contour. This technique effectively addresses complex defects with good functional outcomes and manageable complication rates.
Area of Science:
- Plastic Surgery
- Oral and Maxillofacial Surgery
- Reconstructive Surgery
Background:
- Midface reconstruction after maxillectomy presents significant challenges in restoring contour, oronasal separation, orbital support, and dentition.
- The fibula osteocutaneous free flap is a complex reconstructive option for these defects.
Purpose of the Study:
- To present a specific technique for midface reconstruction using fibula osteocutaneous free flaps.
- To evaluate the surgical and functional outcomes of this reconstructive method.
- To identify and discuss potential pitfalls to avoid for improved results.
Main Methods:
- Retrospective review of patients undergoing maxillary reconstruction with fibula osteocutaneous free flaps.
- Analysis of defect types (Cordeiro type 2 and 3a), concurrent procedures (orbital reconstruction), and implant placement.
- Evaluation of flap take-back, flap loss, and complication rates (hardware exposure, palatal fistulas).
Main Results:
- Eighty-five flaps were performed in 73 patients, with 95.9% receiving osseointegrated dental implants.
- Low rates of total flap loss (2.7%) and palatal fistulas (5.5%) were observed.
- High functional success rates were reported, with 79.5% excellent speech and 80.9% unrestricted diet.
Conclusions:
- Maxillary reconstruction with free fibula flaps provides reliable restoration of dental, orbital, and midfacial support.
- The study details technique modifications to minimize complications and enhance outcomes.
- This approach is effective for complex midface defects following maxillectomy.
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