“Axial Split Osteotomy” of Free Fibular Flaps for Mandible Reconstruction: Preliminary Results

Abstract

Vascularized free flaps are now considered the most appropriate choice for mandible reconstruction because they offer excellent cosmetic and functional results. Various techniques have been proposed. Free fibular flaps have numerous advantages in terms of versatility and contouring. Shaping can be achieved by wedge osteotomy with excellent results. However, this technique leads to bone loss and may be difficult in the later stages of the procedure. The purpose of this report is to describe a simple and safe flap-shaping method involving axial split osteotomy.

Sculpturing a fibular flap: Combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap

“…''Axial split ostetomy'' of a fibular flap for mandibular angle reconstruction was studied. 12 However, the vertical ostetomy technique performed in our cases aimed for a different purpose. Vertical osteotomy transforms the tubular, cylindrical structure of a fibula into a flat bony surface that can be used for reconstruction of wider bony defects with less vertical height.…”

Fibula free flap splitting for mandible reconstruction: A technical note

“…Then, the osteotomy, as described by Guyot et al [5], is performed with an oscillating saw, making three cuts: (1) First is on the external surface of the fibula, perpendicular to the main axis of the bone (2) the second is made along the main axis of the bone and is between 3 and 5 cm long; and (3) the last is made perpendicular to the internal surface at the junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first cut. The vascular pedicle is protected by placing a blunt dissector in the subperiosteal plane.…”

“…However, this technique has some disadvantages, which include bone loss of 1-3 cm, difficulty making an optimal wedge according to the formula of Kahler and Manders, [4] and increased risk of damaging the vascular pedicle of the flap. To overcome these drawbacks of the wedge osteotomy, Guyot et al [5] published their initial experience with an axial splitting technique for the fibula flap to shape the angle of the neomandible in 2001. Since then, little attention [6] has been given to this elegant, useful technique in the literature.…”

HCV-Related Transformation and New Therapeutic Strategies: An Update

“…The fibula flap [45][46][47][48][49][50][51][52][53][54][55][56][57][58] provides up to 25 cm of uniform bicortical bone. It can be osteotomized multiple times without devascularizing individual segments, thus allowing the greatest precision for shaping the reconstructed mandible.…”