eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Tissue Transfer, Fibula: Follow-up

Author: Mark K Wax, MD, Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University; Service Chief, Department of Surgery, Section of Otolaryngology, Veterans Affairs Medical Center
Coauthor(s): Catherine P Winslow, MD, Consulting Surgeon, Winslow Facial Plastic Surgery, LLC
Contributor Information and Disclosures

Updated: Mar 18, 2009

Outcome and Prognosis

Cosmetic outcomes are generally excellent with this technique. Near-normal contour can be restored with appropriate osteotomies and plating. The skin is a poor color match for the head and neck, and its thickness precludes good camouflage. Some patients opt for tattooing, serial excision, or dermabrasion to lessen the abrupt change in color and consistency. Often, its color more closely approximates normal neck or facial skin once the flap has been exposed to sunlight or irradiated.

Functional rehabilitation is excellent. Patients who are fit with osseointegrated implants can have near-normal mastication and speech. Patients who are unable to afford implants may be fit with dentures, but their ability to chew is not as good. Postoperative voice and deglutition depends on the amount and type of soft-tissue that was resected. Resection of structures such as the lingual and hypoglossal nerves and tongue base limits restoration of normal function.

A temporary limp is not uncommon following fibular harvest. As healing progresses, patients are instructed to work with physical therapists to resume their preoperative functional status. Elderly patients require additional time for recovery necessitating ongoing physical therapy for optimal rehabilitation.

Future and Controversies

The primary controversy related to the fibula free flap relates to the use of preoperative imaging to identify aberrant vascular anatomy. Angiography has been the criterion standard and was recommended by most reconstructive surgeons prior to performing a vascularized fibula flap. However, the invasiveness of the test and the possible morbidity, as well as the risk for peroneal spasm as a result of the vascular irritation, has led to more conservative approaches.

Direct evaluation of the appearance, temperature, and pedal pulses is currently used at the authors' institution to evaluate the presence and patency of all 3 vessels. Many surgeons are confident in proceeding without any imaging, provided the patient has normal pedal pulses. The authors consider the data provided by the duplex Doppler examination worth the added cost of the test in the event of any physical abnormalities to avoid a potential disaster for these few patients with aberrant anatomy. MRA and CT angio have reported results similar to angiography.

 


More on Tissue Transfer, Fibula

Overview: Tissue Transfer, Fibula
Workup: Tissue Transfer, Fibula
Treatment: Tissue Transfer, Fibula
Follow-up: Tissue Transfer, Fibula
Multimedia: Tissue Transfer, Fibula
References
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References

  1. Thankappan K, Trivedi NP, Subash P, et al. Three-dimensional computed tomography-based contouring of a free fibula bone graft for mandibular reconstruction. J Oral Maxillofac Surg. Oct 2008;66(10):2185-92. [Medline].

  2. Disa JJ, Cordeiro PG. The current role of preoperative arteriography in free fibula flaps. Plast Reconstr Surg. Sep 1998;102(4):1083-8. [Medline].

  3. Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg. Feb 2002;128(2):161-6. [Medline].

  4. Garrett A, Ducic Y, Athre RS, Motley T, Carpenter B. Evaluation of fibula free flap donor site morbidity. Am J Otolaryngol. Jan-Feb 2006;27(1):29-32. [Medline].

  5. Ghaheri BA, Kim JH, Wax MK. Second osteocutaneous fibular free flaps for head and neck defects. Laryngoscope. Jun 2005;115(6):983-6. [Medline].

  6. Hidalgo DA. Fibula free flap mandibular reconstruction. Clin Plast Surg. Jan 1994;21(1):25-35. [Medline].

  7. Shindo M, Fong BP, Funk GF, Karnell LH. The fibula osteocutaneous flap in head and neck reconstruction: a critical evaluation of donor site morbidity. Arch Otolaryngol Head Neck Surg. Dec 2000;126(12):1467-72. [Medline].

  8. Urken ML, Cheney ML, Sullivan MJ. Fibula free flaps. Atlas of Regional and Free Flaps for Head and Neck Reconstruction. New. York, NY: Raven Press; 1995.

  9. Wax MK, Winslow CP, Hansen J, et al. A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap. Laryngoscope. Jun 2000;110(6):977-81. [Medline].

  10. Woerdeman LA, Chaplin BJ, Griffioen FM, Bos KE. Sensate osteocutaneous fibula flap: anatomic study of the innervation pattern of the skin flap. Head Neck. Jul 1998;20(4):310-4. [Medline].

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Further Reading

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Keywords

fibula tissue transfer, fibula free flap, fibula, tissue transfer, tissue loss, osteocutaneous free tissue transfer, maxillary defects, mandible reconstruction

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Contributor Information and Disclosures

Author

Mark K Wax, MD, Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University; Service Chief, Department of Surgery, Section of Otolaryngology, Veterans Affairs Medical Center
Mark K Wax, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Catherine P Winslow, MD, Consulting Surgeon, Winslow Facial Plastic Surgery, LLC
Catherine P Winslow, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Terance (Terry) Ted Tsue, MD, Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine
Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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