Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Fibula Tissue Transfer Workup

  • Author: Mark K Wax, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Jan 27, 2015
 

Laboratory Studies

See the list below:

  • Laboratory studies based on patient history
  • Coagulation panel
Next

Imaging Studies

See the list below:

  • Chest radiography to assess chronic obstructive pulmonary disease and metastasis
  • Computed tomography (CT) scanning
    • CT scan findings augment the physical examination findings to assess the anticipated defect size.[4]
    • Consider the size and orientation of the anticipated soft-tissue defect.
    • Three-dimensional modeling may facilitate reconstruction.[5]
Previous
Next

Other Tests

See the list below:

  • 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.[6]
  • Physical examination remains the primary method of evaluation. Abnormal results following physical examination is often enough to mandate a different flap.
Previous
 
 
Contributor Information and Disclosures
Author

Mark K Wax, MD Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science 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 Head and Neck Society, Canadian 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 Laser Medicine and Surgery, North American Skull Base Society, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Javier D Gonzalez-Castro, MD Clinical Instructor, Fellow in Microvascular Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University

Javier D Gonzalez-Castro, 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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David W Stepnick, MD Associate Professor, Departments of Otolaryngology-Head & Neck Surgery and Plastic Surgery, Case Western Reserve University School of Medicine, MetroHealth 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 Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons, American College of Surgeons

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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Terance (Terry) Ted Tsue, MD Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kasnas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, Association for Research in Otolaryngology, American Head and Neck Society, Johns Hopkins Medical and Surgical Association, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Missouri State Medical Association, Phi Beta Kappa, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases wish to thank Catherine P Winslow, MD, Consulting Surgeon, Winslow Facial Plastic Surgery, LLC, for her previous contributions to this article.

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

  2. de la Parra M, Sanchez G, Lopez J, et al. Total maxillary reconstruction using a double-barreled and double skin paddle fibular flap after total maxillectomy. Arch Plast Surg. 2013 Nov. 40(6):779-82. [Medline].

  3. van Gemert JT, van Es RJ, Rosenberg AJ, et al. Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation. J Oral Maxillofac Surg. 2012 Jul. 70(7):1692-8. [Medline].

  4. Toto JM, Chang EI, Agag R, et al. Improved Operative Efficiency of Free Fibula Flap Mandible Reconstruction with Patient-Specific, Computer-Guided Preoperative Planning. Head Neck. 2014 Jun 21. [Medline].

  5. 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. 2008 Oct. 66(10):2185-92. [Medline].

  6. 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. 2011 Jan-Feb. 13(1):36-40. [Medline].

  7. Wax MK. The role of the implantable Doppler probe in free flap surgery. Laryngoscope. 2014 Mar. 124 Suppl 1:S1-12. [Medline].

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

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

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

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

  12. 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. 2000 Dec. 126(12):1467-72. [Medline].

  13. 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.

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

Previous
Next
 
Complex defect involving anterior mandibular arch.
The fibula free flap is well suited for anterior mandibular arch defects. The complete arch can be rebuilt following shaping of the bone.
Patient with plate exposure after reconstruction of a mandibular defect without the use of an osteocutaneous flap.
Angiogram showing poor candidate for fibular flap. Solid arrow: anterior tibial artery. Hollow arrow: peroneal artery. Short arrow: plantar artery from posterior tibial artery.
Patient with poor circulation to the lower leg following fibula free flap harvesting.
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.
Donor site closure.
Patient with osseointegrated implants in flap.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.