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J Maxillofac Oral Surg 2022 Jun 19;21(2):320-325. Epub 2020 Nov 19.

Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Navanagar, Bagalkot, Karnataka India.

Background: The free fibula flap (FFF) has proved to be an adequate adjunct tool in the reconstruction of defects following cancer ablation. Although various investigation tools in the past have been proved to be adequate to study the blood supply of the various trunks of arteries, for the survival of graft, the color Doppler flow study (CDF) can be done for the accurate examination of various perforators for the same in the lower limbs prior to its harvest.

Materials And Methods: 40 patients were included in the study and were examined for free fibula flap tissue transfer via color Doppler study for the lower limb perforators. Read More

Proc (Bayl Univ Med Cent) 2022 3;35(3):391-393. Epub 2022 Mar 3.

Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of Dentistry, Dallas, Texas.

Ameloblastomas are benign, locally invasive odontogenic tumors that comprise approximately 1% of tumors within the jaws, with 66% located in the posterior mandible. If left untreated, these lesions can reach enormous size, resulting in considerable deformity and associated morbidity. Traditionally, defects >6 cm warranted a free-flap fibula transfer or iliac crest autogenous graft. Read More

Br J Oral Maxillofac Surg 2022 Feb 18. Epub 2022 Feb 18.

Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP and Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK. Electronic address:

The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Read More

Oral Oncol 2022 04 24;127:105765. Epub 2022 Feb 24.

University of Alberta - Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada; Institute for Reconstructive Sciences in Medicine, Misericordia Hospital, 16940 87 Avenue NW, Edmonton, Alberta T5R 4H5, Canada. Electronic address:

Introduction: Jaw defect reconstructions have been transformed by the development of free tissue transfer using vascularized bone incorporating osseointegrated dental implants. We recently developed a modification our method this procedure and termed it the Modified Alberta Reconstruction Technique (MART). The objective of this study aimed to assess the soft tissue component and outcomes of the MART as compared to the Alberta Reconstructive Technique (ART) or conventional (BDD) reconstructions. Read More

Injury 2022 Apr 9;53(4):1430-1437. Epub 2022 Feb 9.

Department of Hand & Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China. Electronic address:

Background: Extensive composite extremity defects remain a challenge in plastic and reconstructive surgery. To preserve the extremity, we used combined transfer composed of the vascularized fibula flap and a perforator flap from various body parts to reconstruct extensive composite extremity defects.

Patients And Methods: From January 2004 to December 2018, 14 male patients aged 9 to 55 years with extensive composite extremity defects (large soft-tissue and long bone defect) underwent reconstructive surgery in our institution. Read More

Ann R Coll Surg Engl 2022 Feb 17. Epub 2022 Feb 17.

Jaslok Hospital and Research Centre, Mumbai, India.

Introduction: Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic outcomes.

Methods: Between 2014 and 2020, some 524 patients underwent microvascular reconstruction. Read More

Eur Arch Otorhinolaryngol 2022 Feb 1. Epub 2022 Feb 1.

Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.

Purpose: The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. Read More

Cureus 2021 Dec 1;13(12):e20088. Epub 2021 Dec 1.

Otolaryngology-Head and Neck Surgery, Keck School of Medicine at University of Southern California, Los Angeles, USA.

Due to the microvascular effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), head and neck reconstructive surgeries utilizing free tissue transfers may be profoundly affected by SARS-CoV-2 infection in the immediate postoperative period. Our objective is to describe two adult patients who developed SARS-CoV-2 after undergoing relatively uncomplicated segmental mandibulectomies. In both cases, the patients were initially negative for SARS-CoV-2, underwent relatively uncomplicated segmental mandibulectomies with fibula free flap reconstructions, and were later discharged in stable conditions. Read More

Arch Plast Surg 2021 Nov 15;48(6):699-702. Epub 2021 Nov 15.

Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. Read More

Microsurgery 2022 Feb 16;42(2):187-191. Epub 2021 Nov 16.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.

Severe trismus often causes significant compromise in quality of life due to severe impairment of oral functions. Treatment of trismus needs to be tailored to the cause. Here, we report the case of a successful treatment for severe trismus after maxillectomy using coronoidectomy, condylectomy, and vascularized fibula flap transfer. Read More

J Craniofac Surg 2022 May 6;33(3):867-869. Epub 2021 Oct 6.

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

Abstract: Complex oromandibular defects are usually too extensive or complex to be reconstructed with a single free flap. In this situation, dual free flaps can provide an adequate amount of tissues and a three-dimensional structure for large composite defects.In our institution, a total of 6 patients underwent immediate dual free-flap reconstruction between December 2013 and February 2020. Read More

J Hand Surg Asian Pac Vol 2021 Sep;26(3):455-459

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. Read More

J Long Term Eff Med Implants 2021 ;31(3):63-67

Trauma and Orthopaedic Department, "Korgialenio-Benakio" Hellenic Red Cross Hospital, Athens, Greece; Trauma and Orthopaedic Department, Ealing Hospital, North West University Healthcare NHS Trust, London, United Kingdom.

Fractures of the tibia shaft are the most common long bone fractures, especially in young male adults. Due to specific anatomical features, these fractures are more common than any other long-bone fracture. This is one of the main reasons they are associated with twice the incidences of deep infection compared with any other bone and can be combined with the presence of segmental bone defect. Read More

JAMA Otolaryngol Head Neck Surg 2021 12;147(12):1035-1044

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.

Importance: Aesthetic outcomes are key determinants of psychosocial functioning among surgically treated patients with head and neck cancer (HNC); however, long-term aesthetic outcomes after microvascular free tissue transfer (MFTT) are not well described.

Objective: To examine risk factors for impaired long-term aesthetic satisfaction and appearance-related psychosocial functioning after HNC ablation with MFTT.

Design, Setting, And Participants: A cross-sectional, web-based survey was conducted at an academic tertiary care center. Read More

J Craniofac Surg 2022 Jan-Feb 01;33(1):e28-e30

Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium.

Background: Several recent reports have described the development and use of three-dimensional (3D) printed surgical osteotomy guides. However, these methods: are usually costly. Here, we introduce a novel method of manufacturing surgical guides built from inexpensive, easy-to-use, and sterilizable dental impression silicone. Read More

J Orthop Case Rep 2021 Mar;11(3):52-54

Department of Orthopedics, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.

Introduction: Non-union of closed humerus fractures is estimated to be about 5.5% and this figure is even higher in open fractures. In cases of non-union of the humerus with segmental bone defect, if a conventional treatment has failed, free fibular transfer is often considered for satisfactory bone union. Read More

J Am Acad Orthop Surg Glob Res Rev 2021 07 7;5(7). Epub 2021 Jul 7.

From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Houdek and Dr. Wellings); Mayo Clinic School of Medicine, Rochester, MN (Saifuddin); and the Division of Plastic and Reconstructive Surgery, Mayo Clinic (Dr. Moran).

Tumors involving the epiphysis in children present a reconstructive challenge. A free vascularized fibula epiphyseal transfer offers a means for biological reconstruction and longitudinal growth; however, it is often complicated by graft fracture and limited shoulder motion. Here, we present a case of a composite structural allograft with free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Read More

BMJ Case Rep 2021 Jun 7;14(6). Epub 2021 Jun 7.

Plastic Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK.

Vascularised epiphysial fibula bone transfers in the paediatric population provides a solution to growth suppression in extremity reconstruction. We report a case of an anatomical variant to the epiphysial blood supply that has never been reported in literature. A 6-year-old girl underwent a free vascularised fibula flap for reconstruction of her right humerous following osteosarcoma resection. Read More

Diagn Interv Radiol 2021 May;27(3):432-439

Lateral hindfoot impingement (LHI) is a subtype of ankle impingement syndrome with classic MRI findings. Biomechanically, LHI is the sequela of lateral transfer of weight bearing from the central talar dome to the lateral talus and fibula. The transfer occurs due to collapse of the medial arch of the foot, most commonly from posterior tibial tendon (PTT) and spring ligament (SL) insufficiency. Read More

J Plast Reconstr Aesthet Surg 2021 Oct 29;74(10):2504-2511. 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 08 31;43(8):2342-2352. 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

Int J Surg Pathol 2021 Oct 11;29(7):798-803. Epub 2021 Mar 11.

National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa.

Adamantinoma-like Ewing sarcoma is a rare variant of Ewing sarcoma with histologic and immunohistochemical evidence of squamous differentiation. This variant most commonly occurs in the head and neck region with a few cases reported in the long bones of the limbs. It may be associated with poorer clinical outcome and could pose a diagnostic challenge, particularly if it occurs in older patients or as a metastatic lesion. Read More

Microsurgery 2021 May 7;41(4):327-334. Epub 2021 Mar 7.

Department of Stomatology, MacKay Memorial Hospital, Taipei, Taiwan.

Purpose: Although two ways of reconstruction have been reviewed for a long period, comparison of large sample size with nearly randomized patient selection is rare. Here, we compare the surgical outcomes of these two methods from two large medical institutes.

Methods: Totally 176 patients were included from two medical centers with different protocols, 62 patients from MacKay Hospital repair defects with fibula flaps using reconstruction plates. 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

Ann Plast Surg 2021 04;86(4):428-433

Deparrtment of Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India.

Background: The facial profile requires adequate maxillary and mandibular projection. Although oral cancer tumor ablation might create ipsilateral maxillary and mandibular defect, fibular flap is popular in mandibular defect reconstruction. However, the maxillary defect results in sunken cheek or oral contracture. Read More

Laryngoscope 2021 09 11;131(9):1997-2005. 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 Jul 31;37(6):524-529. 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 2021 Jul 23;130(7):843-847. 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