Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

Abstract

Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. Results: The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap – one of the largest reported in the literature – as a single mode of reconstruction.

Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors

“…Patients' anxiety causes sympathetic nerve function to become more active, promotes the secretion of adrenaline in the patient's body, shrinks small blood vessels, and reduces the blood supply to the transplant area, thus affecting blood circulation in the flap transplant area. [18][19][20] The success of skin flap transplantation surgery relies not only on the proficiency of the operating surgeon, but also on the integral role of perioperative care. Therefore, in addition to active treatment, nursing interventions are crucial to ensure a favorable outcome.…”

Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

“…Various strategies are described to avoid these complications and to solve this clinically demanding situation (13). These strategies include a revival of pedicled local flaps, harvest of a chimeric free fibula flap (two fasciocutaneous paddles based on a second random perforator or an additional soleus perforator flap) (14)(15)(16) or intraoral lining with the muscles (posterior tibial and flexor hallucis longus muscles), and extraoral positioning of the fasciocutaneous flap. Another more standardized and widely performed approach is the transfer of double or sandwich flaps (11,17,18)..…”