Donor-site necrosis following fibula free-flap transplantation: A report of three cases

Klein, Steven; Hage, J. Joris; Woerdeman, Leonie A. E.

doi:10.1002/micr.20169

Cited by 36 publications

(29 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hence, multiple osteotomies of the fibula to confirm to the maxilla and mandible are feasible without devascularising individual segments. Moreover FFF offers tremendous bicortical bone stock for dental implant placement and a versatile cutaneous unit for concomitant soft tissue reconstruction [2][3][4][5][6][7][8][9]. Also FFF based on separate septocutaneous perforators is of benefit to extensive substitution to externally cutaneous and internally oral linings [10].…”

Section: Introductionmentioning

confidence: 99%

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Shroff

Nair

Shah

et al. 2016

J. Maxillofac. Oral Surg.

View full text Add to dashboard Cite

Purpose To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region. Patients and MethodsThe investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study. Results The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %. Conclusion The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.

show abstract

Section: Introductionmentioning

confidence: 99%

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Shroff

Nair

Shah

et al. 2016

J. Maxillofac. Oral Surg.

View full text Add to dashboard Cite

show abstract

“…These include impaired wound healing, cellulitis, transient sensory loss in the peroneal nerve territory, cold intolerance, calf muscle weakness, pain or cramp, impingement on peroneal muscles, edema of the leg after prolonged standing, esthetically unsatisfactory scar, valgus deformity, instability or stiffness of the ankle, gait disturbance, restriction of the big toe in dorsiflexion and plantar flexion, compartment syndrome, and limb loss. 2,3 The DCIA free flap has not been without complications, which include gait disturbance, hernia, femoral nerve weakness, pain, tightness, hypertrophic scar, seroma, wound infection, and inclusion cyst. 4 The fibula and DCIA free flap donor sites have been directly compared in the literature.…”

mentioning

confidence: 99%

Donor-Site Morbidity of Free Fibula and DCIA Flaps

Ling¹,

Peng²,

Samman³

2013

Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

“…Similarly, most of the complications in other series are minor complications such as great toe contractures that do not require any intervention. 4,12 Postoperative foot ischemia and necrosis is undoubtedly the greatest and most severe complication. It is relatively uncommon, and there is no clear information on its incidence.…”

Section: Discussionmentioning

confidence: 99%

“…3 Loss of skin graft applied to the donor site, cellulitis, wound healing problems, and abscesses are among the short-term complications; whereas weakness in the foot, ankle instability, great toe contracture, or sensory disorders may be seen in the long term. 3,4 The most dreaded major donorsite complication is ischemia of the foot, which is fortunately rare. 5 This condition may result from sacrifice of the peroneal artery in the presence of an underlying traumatic, atherosclerotic, or congenital vascular disorders.…”

mentioning

confidence: 99%

Foot Ischemia After a Free Fibula Flap Harvest

Saydam¹,

Başaran²,

Ceran³

et al. 2014

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

The most dreaded major donor-site complication of free fibula flap is a foot ischemia, which is fortunately rare. Various authors have discussed the efficacy of the use of preoperative imaging methods including color Doppler, magnetic resonance angiography, and conventional angiography. A 25-year-old man presented with a 10-cm mandibular defect after a facial gunshot injury. Lower extremity color Doppler revealed triphasic peroneal, tibialis anterior, and posterior artery flows. A fibula osteocutaneous flap was harvested, and the mandible was reconstructed. However, the suture sites at the donor site began to demonstrate signs of necrosis, abscess formation, and widespread cellulitis beginning from postoperative day 9. Angiogram of the lower extremity on the 13th day demonstrated no flow in the right posterior tibial artery distal to the popliteal artery, whereas the anterior tibial artery had weak flow with collateral filling distally. An emergency bypass with a saphenous vein graft between the popliteal artery and the distal posterior tibial artery was performed. Repeated debridements, local wound care, and vacuum-assisted closure were applied. A skin graft was placed eventually. The extremity healed without severe functional disability. In conclusion, although the arterial anatomy is completely normal in preoperative evaluation, vascular complications may still ocur at the donor fibula free flap site. In addition, emergency cardiovascular bypass surgery, as we experienced, may be necessary for limb perfusion.

show abstract

Donor-site necrosis following fibula free-flap transplantation: A report of three cases

Cited by 36 publications

References 23 publications

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Donor-Site Morbidity of Free Fibula and DCIA Flaps

Foot Ischemia After a Free Fibula Flap Harvest

Contact Info

Product

Resources

About