Fibula Tissue Transfer Workup

  • Author: Mark K Wax, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 5, 2012
 

Laboratory Studies

  • Laboratory studies based on patient history
  • Coagulation panel
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Imaging Studies

  • Chest radiography to assess chronic obstructive pulmonary disease and metastasis
  • CT scanning
    • CT scan findings augment the physical examination findings to assess the anticipated defect size.
    • Consider the size and orientation of the anticipated soft-tissue defect.
    • 3-Dimensional modeling may facilitate reconstruction.[2]
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Other Tests

  • The role of preoperative Doppler examination or angiographic imaging to evaluate the vascular anatomy of the leg is disputed (see Future and Controversies).
  • Magnetic resonance angiography (MRA) has been used to assess the vascular supply of the leg. Expense has relegated its use to a small number of centers.[3]
  • Physical examination remains the primary method of evaluation. Abnormal results following physical examination is often enough to mandate a different flap.
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 of Otolaryngology, Dentistry, and Engineering, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. Sun GH, Patil YJ, Harmych BM, Hom DB. Inpatients with gunshot wounds to the face. J Craniofac Surg. Jan 2012;23(1):e62-5. [Medline].

  2. 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].

  3. Miller ME, Moriarty JM, Blackwell KE, Finn JP, Yiee JH, Nabili V. Preoperative magnetic resonance angiography detection of septocutaneous perforators in fibula free flap transfer. Arch Facial Plast Surg. Jan-Feb 2011;13(1):36-40. [Medline].

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

  5. 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].

  6. 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].

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

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

  9. 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].

  10. 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.

  11. 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].

  12. 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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The fibula free flap is well suited to anterior arch defects. The complete arch can be rebuilt following shaping of the bone.
Fibula harvest following osteotomies. After complete dissection of the pedicle and preparation of the recipient site, the pedicle is transected.
Following harvest, the proximal bone is trimmed and osteotomies are performed if necessary. The reconstruction plate is used as a template for shaping the bone.
 
 
 
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