The Proximal Fibula Bone Flap for Complex Maxillary Reconstruction: Anatomic Evaluation and a Case Report

Area of Science:

• Plastic Surgery
• Oral and Maxillofacial Surgery
• Vascular Anatomy

Background:

• Total maxillectomy defects present significant reconstructive challenges, particularly for the orbital rim and alveolus.
• The fibula flap is a standard for craniofacial bone reconstruction, but the proximal segment is often discarded.
• This study investigates the vascular supply of the proximal fibula for potential reconstructive use.

Purpose of the Study:

• To evaluate the vascular anatomy of the proximal fibular segment.
• To determine the feasibility of using the proximal fibula as a separate vascularized bone flap.
• To reconstruct complex maxillectomy defects using this novel approach.

Main Methods:

• Anatomical study of peroneal vessels in clinical cases and CT angiograms.
• Dissection of proximal peroneal artery and vein branches in 25 patients undergoing fibula flap harvest.
• Reconstruction of a hemi-maxillectomy defect using a proximal fibula flap as a flow-through graft.

Main Results:

• A consistent perforating branch of the peroneal vessels supplies the proximal fibula.
• Successful reconstruction of a hemi-maxillectomy defect, including orbital rim restoration.
• Excellent patient outcomes at 15-month follow-up, with good orbital position and vision.

Conclusions:

• The proximal fibula is reliably supplied by peroneal vessels and can be harvested as a vascularized perforator bone flap.
• This technique offers a valuable addition to reconstructive options for total maxillectomy defects.
• The proximal fibula flap provides a viable solution for orbital rim and alveolar reconstruction.