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J Plast Reconstr Aesthet Surg 2021 Mar 29. Epub 2021 Mar 29.

Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center Lebanon. Electronic address:

Background: Pediatric sarcomas are the most common malignancies of bones in childhood. With advances in adjuvant treatment, limb salvage surgery has become common, increasing the demand of skeletal reconstruction. Traditional practice included bone grafting and transport. Read More

Head Neck 2021 Mar 31. Epub 2021 Mar 31.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background: To determine whether virtual surgical planning and three-dimensional printed cutting guides (3D/VSP) improved radiographic bone union compared to conventional methods (CM) in fibula free flap (FFF) reconstruction of the mandibles.

Methods: Retrospective study from the years 2000-2018 at a tertiary hospital. Osseous union was evaluated by a radiologist blinded to each patient's treatment. Read More

Cancers (Basel) 2021 Feb 18;13(4). Epub 2021 Feb 18.

Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.

Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Read More

Laryngoscope 2021 Feb 11. Epub 2021 Feb 11.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, U.S.A.

Objectives/hypothesis: To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications.

Study Design: Retrospective chart review.

Methods: A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15-year period. Read More

J Reconstr Microsurg 2021 Jan 31. Epub 2021 Jan 31.

Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.

Background:  Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. Read More

Int J Surg Case Rep 2020 4;77:472-475. Epub 2020 Nov 4.

Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia. Electronic address:

Introduction: The management of large bone defect in the upper limb is fraught with difficulties and problems. It's is a long course treatment which include many components: infection, osseous loosening and shortening.

Case Presentation: We present our experience of an 12-years-old boy with septic non union of the proximal left humerus with length discrepancy of 6 cm treated with Ilizarov fixator(IL) followed by vascularized fibula graft (VFG) with a good clinical result without complications. Read More

Ann Otol Rhinol Laryngol 2020 Nov 23:3489420972734. Epub 2020 Nov 23.

Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA.

Objectives: To present a method to reconstruct the midface using the fibula as both a microvascular free flap and as a free cortex graft.

Methods: 22-year-old male presented with bilateral maxillary odonotogenic myxoma. Bilateral total maxillectomy defects were reconstructed using an osteocutaneous fibula free flap. Read More

Arch Craniofac Surg 2020 Oct 20;21(5):269-275. Epub 2020 Oct 20.

Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. Read More

Plast Reconstr Surg Glob Open 2020 Sep 24;8(9):e3149. Epub 2020 Sep 24.

Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.

Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). Read More

J Plast Reconstr Aesthet Surg 2021 02 20;74(2):259-267. Epub 2020 Sep 20.

Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillo-faciale et Stomatologie, Hôpital Beaujon, Université de Paris, Paris, France.

Primary mandibular reconstruction after tumor removal or osteoradionecrosis treatment is a standard procedure. The most common reconstruction techniques are fibula, scapula, and iliac crest free flaps. Nevertheless, all patients are not eligible for microsurgery. Read More

Cureus 2020 Aug 27;12(8):e10073. Epub 2020 Aug 27.

Department of Anesthesia, Aventura Hospital and Medical Center, Aventura, USA.

A 59-year-old male presented with recurrent mucoepidermoid carcinoma of the mandible. A resection with immediate free fibula flap reconstruction was done. The osteocutaneous free fibula flap relies on the peroneal artery and its distal perforators. Read More

Plast Reconstr Surg Glob Open 2020 Jul 23;8(7):e2964. Epub 2020 Jul 23.

Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La.

Resection of large mandibular tumors followed by primary reconstruction using free tissue transfer is typically accomplished using transcutaneous cervical incisions, which provide access for ablation as well as inset of the osseous free flap. This approach offers wide exposure; however, it subjects the patient to potential facial scarring, marginal mandibular nerve injury, lip deformity/incompetence, formation of orocutaneous fistulae, as well as functional impairments to speech, mastication, and deglutition. To reduce morbidity and to preserve aesthetics, a transoral approach can be used in cases that do not require a neck dissection. Read More

Otolaryngol Head Neck Surg 2021 01 7;164(1):104-109. Epub 2020 Jul 7.

Department of Otolaryngology-Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA.

Objective: Papaverine is a topical vasodilator commonly used during microvascular surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an alternative, effective vasodilator. This study aims to assess the experience of a solution of verapamil and nitroglycerin (VG) as a potential alternative pharmacologic vasodilator. Read More

Am J Otolaryngol 2020 Jul - Aug;41(4):102536. Epub 2020 May 12.

Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America. Electronic address:

Learning Objectives: Identify factors associated with skin graft take in fibula free flaps (FFF) and radial forearm free flaps (RFFF) donor sites.

Study Objectives: To determine which factors are associated with decreased skin graft take at the donor site in FFF and RFFF in head and neck patients.

Design: Retrospective Chart Review Case Series. Read More

Laryngoscope 2020 08 15;130(8):E469-E478. Epub 2020 May 15.

Mayo Clinic, Department of Otolaryngology - Head and Neck Surgery, Rochester, Minnesota, U.S.A.

Objectives: To describe pain experience and opioid use after major head and neck reconstructive surgery.

Study Design: Retrospective cohort study.

Methods: Patients undergoing major head and neck surgery with microvascular free tissue transfer (free flaps) at a tertiary academic center were included. Read More

Semin Plast Surg 2020 May 6;34(2):86-91. Epub 2020 May 6.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.

Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions-it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. Read More

Clin Case Rep 2020 Apr 20;8(4):612-616. Epub 2020 Feb 20.

Christine M. Kleinert Institute for Hand and Microsurgery Louisville KY USA.

We present two rare microsurgical reconstructions. A case with phocomelia was treated with lengthening of soft tissues following vascularized fibula grafting with epiphysis, and a case with cleft hand was reconstructed with spare-part toe transfer. Read More

Laryngoscope 2020 12 6;130(12):E811-E816. Epub 2020 Apr 6.

Division of Maxillofacial Surgery, City of Health and Science of Turin Hospital, University of Turin, Turin, Italy.

Objectives/hypothesis: The aim of this study was to explore whether the production of in-hospital, low-cost surgical cutting guides would be possible and to assess different cutting guide shapes to facilitate the surgery and the application with instruments.

Study Design: Cohort study.

Methods: Using free computer-aided design software, surgical cutting guides for the mandible and fibula were designed and used to perform virtual segmental osteotomies and fibula transplants in seven patients. Read More

Otolaryngol Head Neck Surg 2020 May 24;162(5):641-648. Epub 2020 Mar 24.

Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.

Objective: To determine the frequency at which patients with osteocutaneous free flap reconstruction of the head and neck develop long-term complications and identify predisposing perioperative factors.

Study Design: A prospectively maintained database of free flaps performed at a single institution over a 10-year period was queried.

Setting: Single tertiary care referral center. Read More

Am J Otolaryngol 2020 May - Jun;41(3):102436. Epub 2020 Feb 19.

Division of Facial Plastic and Reconstructive Surgery, Boston Medical Center, Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address:

Objective: Fibula free tissue transfer is a common and reliable method for mandibular reconstruction. Functional outcomes from this procedure are dependent on the successful union of the osseous segments postoperatively. This study was conducted to define the maximum gap-size criteria for osseous union to occur at osteotomy sites in fibula free flap reconstruction of the mandible. Read More

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Jun 24;129(6):e257-e263. Epub 2020 Feb 24.

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany. Electronic address:

Because of the long-term and consecutive use of different causative agents, clinicians are increasingly encountering patients needing restoration of the stomatognathic system after surgical resection of highly advanced necroses of the jaw. For plastic restoration in these cases, microvascular reconstruction seems to represent the most viable option. According to the limited data available, the risks of this operation are considered comparable with those faced by other patient cohorts. Read More

Am J Otolaryngol 2020 May - Jun;41(3):102404. Epub 2020 Jan 17.

Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America. Electronic address:

Purpose: Our objective was to understand which variables are associated with hematoma formation at both the donor and recipient sites in head and neck free tissue transfer and if hematoma rates are affected by tourniquet use.

Methods: Patients were identified who underwent free tissue transfer at three institutions, specifically either a radial forearm free flap (RFFF) or a fibula free flap (FFF), between 2007 and 2017. Variables including use of tourniquet, anticoagulation, treatment factors, demographics, and post-operative factors were examined to see if they influenced hematoma formation at either the free tissue donor or recipient site. Read More

Am J Otolaryngol 2020 Mar - Apr;41(2):102374. Epub 2019 Dec 10.

Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.

Introduction: Demonstrate that carefully selected free flap patients may be discharged early after surgery without increasing the rates of postoperative complications or readmissions.

Methods: Based on a published article in Laryngoscope 2016 of 51 free-tissue transfers, a retrospective chart review was performed on an expanded cohort who underwent free-tissue transfer for head and neck reconstruction between February 2010 and May 2018 and discharged by postoperative day 3.

Results: 101 patients who underwent 104 free flaps with average age of 56 (3-84) years old were reviewed. Read More

Injury 2019 Dec 23;50 Suppl 5:S84-S87. Epub 2019 Oct 23.

Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium. Electronic address:

Great evolution has taken place in Orthopaedic Traumatology, regarding techniques, surgical means and equipment. However, we still encounter complicated cases of limb trauma that necessitate microvascular reconstruction. Through three different illustrative cases (one emergency foot revascularization by a free flap, covering an ankle arthrodesis and bridging the anterior tibial artery, one cure of a complex infected tibial non-union with extensive skeletal defect by double barrel fibular transfer and one osteo-chondral reconstruction of the scaphoid proximal pole using a vascularized graft harvested from the femoral medial condyle), the authors remind the Orthopaedic community about the benefits of microsurgery, especially if used in proper indication and timing. Read More

J Clin Orthop Trauma 2019 Oct 14;10(Suppl 1):S231-S233. Epub 2018 Dec 14.

Department of Trauma and Emergency, AIIMS Bhubaneswar, Sijua, Patrapada, Odisha, 751019, India.

Defect in the lateral malleolus along with lateral ligamentous injury of ankle is rare. It occurs mainly due to resection of distal fibula tumors and severe trauma leading to loss of lateral malleolus. Lateral malleoli has the major contribution in weight transmission to foot and ankle stability. Read More

Oral Oncol 2019 10 17;97:69-75. Epub 2019 Aug 17.

Department of Oral and Maxillofacial Surgery/Faculty of Medicine KU Leuven, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Imaging & Pathology, OMFS IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium.

Objectives: We evaluated the accuracy of computer-assisted mandibular reconstructions.

Patients And Methods: We retrospectively reviewed data for 26 patients who had mandibular reconstruction with a microvascular free fibula flap, January 2015 to June 2018. Postoperative mandible models were obtained from computed tomography scans. Read More

Injury 2019 Nov 25;50(11):2070-2074. Epub 2019 Jul 25.

The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Suzhou 215006, PR China. Electronic address:

Background: Reconstruction of post-traumatic long bone defects is a formidable problem. To date, the approaches for bony reconstruction remain controversial. Thus, we aimed to compare the different methods in the treatment of patients with post-traumatic long bone defects, based on the long-term functional and self-evaluation results. Read More

Laryngoscope 2020 03 30;130(3):679-684. Epub 2019 Jul 30.

Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A.

Background: Predictive models to forecast the likelihood of specific outcomes after surgical intervention allow informed shared decision-making by surgeons and patients. Previous studies have suggested that existing general surgical risk calculators poorly forecast head and neck surgical outcomes. However, no large study has addressed this question while subdividing subjects by surgery performed. Read More