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American Association of Plastic Surgeons

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Proof Of Concept: Pre-distracted Fibula Flaps For Mandible Reconstruction With Subsequent Orthognathic Surgery
Lee WT Alkureishi, MBChB, Margaret H. Aasen, MS, Chad A. Purnell, MD, Gregory A. Dumanian, MD, Pravin K. Patel, MD.
Shriners Hospitals for Children, Chicago, IL, USA.

PURPOSE: The fibula flap is the workhorse for mandibular reconstruction, but fibula bone width is not ideal to match mandibular height. In this study, in-situ widening of the fibula with distraction osteogenesis prior to transfer is evaluated as a solution. We present a proof of concept of this technique with a patient series, including one patient who has undergone subsequent orthognathic surgery of their reconstructed mandible.
METHODS: A retrospective review of patients undergoing our technique was performed. A longitudinal fibula osteotomy is made in situ, and distraction is performed in the leg to widen the fibula. After distraction and consolidation periods, flaps were osteotomized and transferred to the mandible.
RESULTS: This technique was applied to three patients (ages 9, 11, and 13) with Pruzansky III mandibular hypoplasia at our institution over 15 years. In all cases, bony union was achieved. Mean surgical followup was 5 years. No significant morbidity occurred at the donor sites. Partial flap resorption was observed a number of years postoperatively in one patient. One patient developed TMJ ankylosis after closed treatment of an unrelated mandible fracture. One patient developed a sinus tract requiring debridement of a partial flap necrosis. One patient has gone on to have orthognathic surgery, including osteotomy of the fibula.
CONCLUSION: In-situ fibula distraction osteogenesis is a novel technique to “pre-laminate" a fibula flap prior to transfer to the mandible. This method allows for the reconstruction of challenging mandibular defects without compromising bone height, pedicle length, or the ability to perform orthognathic surgery.


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