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Freier Fibulatransfer

Analyse einer Serie von 76 konsekutiven mikrochirugischen Operationen und Literaturübersicht

Free fibula transfer

Analysis of 76 consecutive microsurgical procedures and review of the literature

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Zusammenfassung

Seit der Erstbeschreibung durch Taylor 1975 ist der mikrochirurgisch freie Fibulatransfer ein Standardverfahren zur Rekonstruktion knöcherner Defekte, die einen vaskularisierten Knochentransfer erfordern. Verschiedene Modifikationen der freien Fibula sind in der Literatur beschrieben. Eine Serie von 76 konsekutiven, mikrochirurgisch freien Fibulatransfers in einem Zeitraum von 7 Jahren wurde hinsichtlich Art der Rekonstruktion und „Outcome“, der allgemeinen chirurgischen Komplikationen und der „lappenspezifischen“ Komplikationen retrospektiv analysiert. Die postoperativen Verläufe waren in 47 Fällen komplikationslos (62%). Die Gesamtkomplikationsrate betrug bei Extremitätenrekonstruktionen 53%, bei Mandibularekonstruktionen vergleichsweise nur 25%. Bei 58 Patienten konnte zum Zeitpunkt der Nachuntersuchung eine knöcherne Konsolidierung nachgewiesen werden (76%). In 4 Fällen kam es zum kompletten Lappenverlust (5%). Die Komplikationsraten reflektieren die Komplexität der Eingriffe und scheinen sowohl mit der Grunderkrankung als auch den prädisponierenden Risikofaktoren assoziiert zu sein. Die Zukunft wird zeigen, ob Entwicklungen, z. B. im Bereich des „Tissue engineering“, den autologen Knochentransfer ersetzen können.

Abstract

Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.

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Literatur

  1. Ad-El DD, Paizer A, Pidhortz C (2001) Bipedicled vascularized fibula flap for proximal humerus defect in a child. Plast Reconstr Surg 107: 155–157

    Article  CAS  PubMed  Google Scholar 

  2. Amr SM, El-Mofty AO, Amin SN, Morsy AM, El-Malt OM, Abdel-Aal HA (2000) Reconstruction after resection of tumors around the knee: role of the free vascularized fibular graft. Microsurgery 20: 233–251

    Article  CAS  PubMed  Google Scholar 

  3. Ang E, Black C, Irish J, Brown DH, Gullane P, O’Sullivan B, Neligan PC (2003) Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg 56: 92–99

    Article  CAS  PubMed  Google Scholar 

  4. Anthony JP, Rawnsley JD, Benhaim P, Ritter EF, Sadowsky SH, Singer MI (1995) Donor leg morbidity and function after fibula free flap mandible reconstruction. Plast Reconstr Surg 96: 146–152

    CAS  PubMed  Google Scholar 

  5. Anthony JP, Foster RD, Sharma AB, Kearns GJ, Hoffman WY, Pogrel MA (1996) Reconstruction of a complex midfacial defect with the folded fibular free flap and osseointegrated implants. Ann Plast Surg 37: 204–210

    CAS  PubMed  Google Scholar 

  6. Anthony JP, Foster RD, Pogrel MA (1997) The free fibula bone graft for salvaging failed mandibular reconstructions. J Oral Maxillofac Surg 55: 1417–1421

    CAS  PubMed  Google Scholar 

  7. Babovic S, Johnson CH, Finical SJ (2000) Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests. J Reconstr Microsurg 16: 107–110

    Article  CAS  PubMed  Google Scholar 

  8. Bahr W, Stoll P, Wachter R (1998) Use of the „double barrel“ free vascularized fibula in mandibular reconstruction. J Oral Maxillofac Surg 56: 38–44

    CAS  PubMed  Google Scholar 

  9. Banic A, Hertel R (1993) Double vascularized fibulas for reconstruction of large tibial defects. J Reconstr Microsurg 9: 421–428

    CAS  PubMed  Google Scholar 

  10. Berend KR, Gunneson EE, Urbaniak JR (2003) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85: 987–993

    Google Scholar 

  11. Bodde EW, Visser E de, Duysens JE, Hartman EH (2003) Donor-site morbidity after free vascularized autogenous fibular transfer: subjective and quantitative analyses. Plast Reconstr Surg 111: 2237–2242

    PubMed  Google Scholar 

  12. Brunelli G, Brunelli G (1991) Free microvascular fibular transfer for idiopathic femoral head necrosis: long-term follow-up. J Reconstr Microsurg 7: 285–295

    CAS  PubMed  Google Scholar 

  13. Brunelli GA, Vigasio A, Brunelli GR (1995) Microvascular fibular grafts in skeleton reconstruction. Clin Orthop 314: 241–246

    PubMed  Google Scholar 

  14. Camilleri I, Wilson GR, McLean NR (1994) Mandibular reconstruction using a ‚parasitic‘ flap. Br J Oral Maxillofac Surg 32: 373–374

    CAS  PubMed  Google Scholar 

  15. Carr AJ, Macdonald DA, Waterhouse N (1988) The blood supply of the osteocutaneous free fibular graft. J Bone Joint Surg Br 70: 319–321

    CAS  PubMed  Google Scholar 

  16. Celebioglu S, Unlu RE, Kocer U, Sensoz O, Mengi AS (1998) Reconstruction of mandible with fibula free flap. Microsurgery 18: 156–159

    Article  CAS  PubMed  Google Scholar 

  17. Chang DW, Langstein HN (2003) Use of the free fibula flap for restoration of orbital support and midfacial projection following maxillectomy. J Reconstr Microsurg 19: 147–152

    Article  PubMed  Google Scholar 

  18. Chang YM, Santamaria E, Wei FC, Chen HC, Chan CP, Shen YF, Hou SP (1998) Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction. Plast Reconstr Surg 102: 680–688

    CAS  PubMed  Google Scholar 

  19. Chang MC, Lo WH, Chen CM, Chen TH (1999) Treatment of large skeletal defects in the lower extremities using double-strut, free vascularized fibular bone grafting. Orthopedics 22: 739–744

    CAS  PubMed  Google Scholar 

  20. Chang DW, Oh HK, Robb GL, Miller MJ (2001) Management of advanced mandibular osteoradionecrosis with free flap reconstruction. Head Neck 23: 830–835

    Article  CAS  PubMed  Google Scholar 

  21. Chen ZW, Yan W (1983) The study and clinical application of the osteocutaneous flap of fibula. Microsurgery 4: 11–16

    CAS  PubMed  Google Scholar 

  22. Chen HC, Demirkan F, Wei FC, Cheng SL, Cheng MH, Chen IH (1999) Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 103: 839–845

    CAS  PubMed  Google Scholar 

  23. Cheung SW, Anthony JP, Singer MI (1994) Restoration of anterior mandible with the free fibula osseocutaneous flap. Laryngoscope 104: 105–113

    CAS  PubMed  Google Scholar 

  24. Cho BC, Kim SY, Lee JH, Ramasastry SS, Weinzweig N, Baik BS (1998) Treatment of osteonecrosis of the femoral head with free vascularized fibular transfer. Ann Plast Surg 40: 586–593

    CAS  PubMed  Google Scholar 

  25. Cho BC, Kim SY, Park JW, Baik BS (2001) Blood supply to osteocutaneous free fibula flap and peroneus longus muscle: prospective anatomic study and clinical applications. Plast Reconstr Surg 108: 1963–1971

    Article  CAS  PubMed  Google Scholar 

  26. Cho BC, Shin DP, Byun JS, Park JW, Baik BS (2002) Monitoring flap for buried free tissue transfer: its importance and reliability. Plast Reconstr Surg 110: 1249–1258

    Article  PubMed  Google Scholar 

  27. Chung YK, Hong JP, Kang SY, Kim SW, Tark KC (2000) A vascularized osteocutaneous fibular free flap for reconstruction of a complex injury of the foot. Ann Plast Surg 45: 541–543

    CAS  PubMed  Google Scholar 

  28. Coghlan BA, Townsend PL (1993) The morbidity of the free vascularised fibula flap. Br J Plast Surg 46: 466–469

    CAS  PubMed  Google Scholar 

  29. Concannon MJ, Croll GH, Boschert MT, Gaines RW, Puckett CL (1993) Free fibular transfer in a growing individual (long-term results). Microsurgery 14: 624–627

    CAS  PubMed  Google Scholar 

  30. Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY (1999) Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 104: 1314–3120

    CAS  PubMed  Google Scholar 

  31. Daniel RK, Weiland AJ (1982) Free tissue transfers for upper extremity reconstruction. J Hand Surg [Am] 7: 66–76

    Google Scholar 

  32. Dautel G, Duteille F, Merle M (2001) Use of osteocutaneous „double-barrel fibular flaps“ in limb reconstruction: four clinical cases. Microsurgery 21: 340–344

    Article  CAS  PubMed  Google Scholar 

  33. De Boer HH, Wood MB (1989) Bone changes in the vascularized fibular graft. J Bone Joint Surg Br 71: 374–378

    CAS  PubMed  Google Scholar 

  34. De Boer HH, Wood MB, Hermans J (1990) Reconstruction of large skeletal defects by vascularized fibula transfer. Factors that influenced the outcome of union in 62 cases. Int Orthop 14: 121–128

    PubMed  Google Scholar 

  35. Deschler DG, Hayden RE (1997) Bone spur presenting as a submandibular mass following free fibula reconstruction of the mandible. Am J Otolaryngol 18: 425–427

    Article  CAS  PubMed  Google Scholar 

  36. Dierks EJ, Karakourtis MH (1997) Segmental resection of the anterior mandibular arch with fibular microvascular reconstruction. Atlas Oral Maxillofac Surg Clin North Am 5: 55–73

    CAS  PubMed  Google Scholar 

  37. Disa JJ, Winters RM, Hidalgo DA (1997) Long-term evaluation of bone mass in free fibula flap mandible reconstruction. Am J Surg 174: 503–506

    Article  CAS  PubMed  Google Scholar 

  38. Dolan RW, McAvoy DW, Carr M (2000) Anatomical variations of the sensory nerves to the fibular osteocutaneous flap. Arch Facial Plast Surg 2: 252–255

    Article  CAS  PubMed  Google Scholar 

  39. Donski PK, Buchler U, Ganz R (1986) Combined osteocutaneous microvascular flap procedure for extensive bone and soft tissue defects in the tibia. Ann Plast Surg 16: 386–398

    CAS  PubMed  Google Scholar 

  40. El-Gammal TA, El-Sayed A, Kotb MM (2002) Hypertrophy after free vascularized fibular transfer to the lower limb. Microsurgery 22: 367–370

    Article  PubMed  Google Scholar 

  41. El-Gammal TA, El-Sayed A, Kotb MM (2003) Reconstruction of lower limb bone defects after sarcoma resection in children and adolescents using free vascularized fibular transfer. J Pediatr Orthop 12: 233–243

    Google Scholar 

  42. Eppley BL, Coleman JJ (2001) Free fibular flap reconstruction in mandibular osteopetrosis. J Craniofac Surg 12: 369–372

    Article  CAS  PubMed  Google Scholar 

  43. Erdmann D, Bergquist GE, Levin LS (2002) Ipsilateral free fibula transfer for reconstruction of a segmental femoral-shaft defect. Br J Plast Surg 55: 675–677

    Article  CAS  PubMed  Google Scholar 

  44. Feingold RS, Argamaso RV, Strauch B (1996) Free fibula flap mandible reconstruction for oral obstruction secondary to giant fibrous dysplasia. Plast Reconstr Surg 97: 196–201

    CAS  PubMed  Google Scholar 

  45. Ferri J, Piot B, Ruhin B, Mercier J (1997) Advantages and limitations of the fibula free flap in mandibular reconstruction. J Oral Maxillofac Surg 55: 440–448

    CAS  PubMed  Google Scholar 

  46. Fong BP, Funk GF (1999) Osseous free tissue transfer in head and neck reconstruction. Facial Plast Surg 15: 45–59

    CAS  PubMed  Google Scholar 

  47. Foster RD, Anthony JP, Singer MI, Kaplan MJ, Pogrel MA, Mathes SJ (1997) Reconstruction of complex midfacial defects. Plast Reconstr Surg 99: 1555–1565

    CAS  PubMed  Google Scholar 

  48. Futran ND, Stack BC Jr, Payne LP (1997) Use of color Doppler flow imaging for preoperative assessment in fibular osteoseptocutaneous free tissue transfer. Otolaryngol Head Neck Surg 117: 660–663

    CAS  PubMed  Google Scholar 

  49. Futran ND, Stack BC Jr, Zaccardi MJ (1998) Preoperative color flow Doppler imaging for fibula free tissue transfers. Ann Vasc Surg 12: 445–450

    Article  CAS  PubMed  Google Scholar 

  50. Futran ND, Wadsworth JT, Villaret D, Farwell DG (2002) Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg 128: 161–166

    PubMed  Google Scholar 

  51. Gianoutsos MP, Marsden FW, McCarthy SW, Lee KK (1994) Ulnar adamantinoma: en bloc excision and fibular osteoseptocutaneous free flap reconstruction. J Hand Surg [Am] 19: 495–499

    Google Scholar 

  52. Goodacre TE, Walker CJ, Jawad AS, Jackson AM, Brough MD (1990) Donor site morbidity following osteocutaneous free fibula transfer. Br J Plast Surg 43: 410–412

    CAS  PubMed  Google Scholar 

  53. Graham RG, Swan MC, Hudson DA, Zyl JE van (2003) The fibula free flap: advantages of the muscle sparing technique. Br J Plast Surg 56: 388–394

    Article  PubMed  Google Scholar 

  54. Guyot L, Richard O, Cheynet F, Sauvant J, Chossegros C, Layoun W, Blanc JL, Gola R (2001) „Axial split osteotomy“ of free fibular flaps for mandible reconstruction: preliminary results. Plast Reconstr Surg 108: 332–335

    Article  CAS  PubMed  Google Scholar 

  55. Hage JJ, Winters HA, Van Lieshout J (1996) Fibula free flap phalloplasty: modifications and recommendations. Microsurgery 17: 358–365

    Article  CAS  PubMed  Google Scholar 

  56. Harrison DH (1986) The osteocutaneous free fibular graft. J Bone Joint Surg Br 68: 804–877

    CAS  PubMed  Google Scholar 

  57. Hartman EH, Spauwen PH, Jansen JA (2002) Donor-site complications in vascularized bone flap surgery. J Invest Surg 15: 185–197

    Article  PubMed  Google Scholar 

  58. Haughey BH, Wilson EA (1996) Fibula free flap. Facial Plast Surg 12: 51–56

    CAS  PubMed  Google Scholar 

  59. Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125: 10–17

    Article  CAS  PubMed  Google Scholar 

  60. Heitmann C, Erdmann D, Levin LS (2002) Treatment of segmental defects of the humerus with an osteoseptocutaneous fibular transplant. J Bone Joint Surg Am 84: 2216–23

    Google Scholar 

  61. Heitmann C, Khan FN, Levin LS (2003) Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 19: 157–162

    Article  PubMed  Google Scholar 

  62. Heller L, Levin LS, Klitzman B (2001) Laser doppler flowmeter monitoring of free tissue-transfer: blood flow in normal and complicated cases. Plast Reconstr Surg 107: 1739–1745

    Article  CAS  PubMed  Google Scholar 

  63. Hervas I, Floria LM, Bello P, Baquero MC, Perez R, Barea J, Iglesias ME, Mateo A (2001) Microvascularized fibular graft for mandibular reconstruction: detection of viability by bone scintigraphy and SPECT. Clin Nucl Med 26: 225–229

    Google Scholar 

  64. Hidalgo DA (1989) Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 84: 71–79

    CAS  PubMed  Google Scholar 

  65. Hidalgo DA (1994) Fibula free flap mandibular reconstruction. Clin Plast Surg 21: 25–35

    CAS  PubMed  Google Scholar 

  66. Hidalgo DA (1994) Fibula free flap mandible reconstruction. Microsurgery 15: 238–244

    CAS  PubMed  Google Scholar 

  67. Hidalgo DA, Rekow A (1995) A review of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg 96: 585–596

    CAS  PubMed  Google Scholar 

  68. Hierner R, Wood MB (1995) Comparison of vascularised iliac crest and vascularised fibula transfer for reconstruction of segmental and partial bone defects in long bones of the lower extremity. Microsurgery 16: 818–826

    CAS  PubMed  Google Scholar 

  69. Hollows P, Hayter JP (2000) Traumatic medial malleolar fracture of a fibula flap donor leg. Br J Plast Surg 53: 166–168

    Article  CAS  PubMed  Google Scholar 

  70. Iconomou TG, Zuker RM, Phillips JH (1999) Mandibular reconstruction in children using the vascularized fibula. J Reconstr Microsurg 15: 83–90

    CAS  PubMed  Google Scholar 

  71. Ihara K, Doi K, Yamamoto M, Kawai S (1998) Free vascularized fibular grafts for large bone defects in the extremities after tumor excision. J Reconstr Microsurg 14: 371–376

    CAS  PubMed  Google Scholar 

  72. Inigo F, Rojo P, Ysunza A, Jimenez Y (1997) Three different techniques for mandibular reconstruction after hemimandibulectomy. J Craniofac Surg 8: 58–64

    CAS  PubMed  Google Scholar 

  73. Ito T, Kohno T, Kojima T (1984) Free vascularized fibular graft. J Trauma 24: 756–760

    CAS  PubMed  Google Scholar 

  74. Jones NF, Elahi MM (2000) Osteosynthesis and bony healing between two consecutive free fibular bone grafts. Plast Reconstr Surg 105: 166–170

    CAS  PubMed  Google Scholar 

  75. Jones NF, Johnson JT, Shestak KC, Myers EN, Swartz WM (1996) Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 cases. Ann Plast Surg 36: 37–43

    CAS  PubMed  Google Scholar 

  76. Jupiter JB, Kour AK (1991) Reconstruction of the humerus by soft tissue distraction and vascularized fibula transfer. J Hand Surg [Am] 16: 940–943

    Google Scholar 

  77. Kamei Y, Aoyama H, Yokoo K, Hayashi Y, Fujii K, Kondo C, Sato Y (2001) Possibility of venous return through bone marrow in the free fibular osteocutaneous flap. Ann Plast Surg 47: 450–452

    Article  CAS  PubMed  Google Scholar 

  78. Kessler P, Wiltfang J, Schultze-Mosgau S, Lethaus B, Greess H, Neukam FW (2001) The role of angiography in the lower extremity using free vascularized fibular transplants for mandibular reconstruction. J Craniomaxillofac Surg 29: 332–336

    Article  CAS  PubMed  Google Scholar 

  79. Kildal M, Wei FC, Chang YM, Huang WC, Chang KJ (2001) Reconstruction of bilateral extensive composite mandibular defects after osteoradionecrosis with two fibular osteoseptocutaneous free flaps. Plast Reconstr Surg 108: 963–967

    Article  CAS  PubMed  Google Scholar 

  80. Kildal M, Wei FC, Chang YM, Chen HC, Chang MH (2001) Mandibular reconstruction with fibula osteoseptocutaneous free flap and osseointegrated dental implants. Clin Plast Surg 28: 403–410

    CAS  PubMed  Google Scholar 

  81. Kim HS, Jahng JS, Han DY, Park HW, Chun CH (1998) Immediate ipsilateral fibular transfer in a large tibial defect using a ring fixator. A case report. Int Orthop 22: 321–324

    Article  CAS  PubMed  Google Scholar 

  82. Kind GM, Buntic RF, Buncke GM, Cooper TM, Siko PP, Buncke HJ (1998) The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 101: 1268–1273

    CAS  PubMed  Google Scholar 

  83. Kirita T, Sugiura T, Horiuchi K, Morimoto Y, Yazima H, Sugimura M (2001) Mandibular reconstruction using a vascularised fibula osteocutaneous flap in a patient with pyknodysostosis. Br J Plast Surg 54: 712–714

    Article  CAS  PubMed  Google Scholar 

  84. Klein S, Hage JJ, Horst CM van der, Lagerweij M (2003) Ankle-arm index versus angiography for the preassessment of the fibula free flap. Plast Reconstr Surg 111: 735–743

    Article  PubMed  Google Scholar 

  85. Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T (1998) Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects. J Reconstr Microsurg 14: 529–534

    CAS  PubMed  Google Scholar 

  86. Koshima I, Higaki H, Soeda S (1991) Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm. Plast Reconstr Surg 88: 338–341

    CAS  PubMed  Google Scholar 

  87. Krishnan KG, Muller A (2002) Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula—a technical report and review of the relevant literature. Eur Spine J 11: 176–182

    Article  PubMed  Google Scholar 

  88. Kusakabe N, Takagi M, Tsuzuki N (1992) Tibio-talo-calcaneal fusion with a free vascularized fibular graft in comminuted open fractures of the talus and the calcaneus. J Orthop Trauma 6: 386–390

    CAS  PubMed  Google Scholar 

  89. Lam LK, Wei WI, Chan VS, Ng RW, Ho WK (2002) Microvascular free tissue reconstruction following extirpation of head and neck tumour: experience towards an optimal outcome. J Laryngol Otol 116: 929–936

    Article  CAS  PubMed  Google Scholar 

  90. Lee KS, Park JW (1999) Free vascularized osteocutaneous fibular graft to the tibia. Microsurgery 19: 141–147

    CAS  PubMed  Google Scholar 

  91. Lee JH, Kim MJ, Kim JW (1995) Mandibular reconstruction with free vascularized fibular flap. J Craniomaxillofac Surg 23: 20–26

    CAS  PubMed  Google Scholar 

  92. Lee HB, Tark KC, Kang SY, Kim SW, Chung YK (2000) Reconstruction of composite metacarpal defects using a fibula free flap. Plast Reconstr Surg 105: 1448–1452

    CAS  PubMed  Google Scholar 

  93. Levin L, Carrasco L, Kazemi A, Chalian A (2003) Enhancement of the fibula free flap by alveolar distraction for dental implant restoration: report of a case. Facial Plast Surg 19: 87–94

    Article  PubMed  Google Scholar 

  94. Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, Urbaniak JR (2003) Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 52: 337–355

    PubMed  Google Scholar 

  95. Lutz BS, Wei FC, Ng SH, Chen IH, Chen SH (1999) Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases. Plast Reconstr Surg 103: 121–127

    Google Scholar 

  96. Lydaki E, Bolonaki I, Stiakaki E, Kambourakis A, Cordeiro PB, Meyers PA, Delides G, Hatzimanolis P, Kalmanti M (2000) Immediate free flap mandibular reconstruction in osteosarcoma of the mandible in childhood. Pediatr Hematol Oncol 17: 335–340

    Article  CAS  PubMed  Google Scholar 

  97. Malizos KN, Beris AE, Xenakis TA, Korobilias AB, Soucacos PN (1992) Free vascularized fibular graft: a versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone. Microsurgery 13: 182–187

    CAS  PubMed  Google Scholar 

  98. Marchetti C, Degidi M, Scarano A, Piattelli A (2002) Vertical distraction osteogenesis of fibular free flap in mandibular prosthetic rehabilitation: a case report. Int J Periodontics Restorative Dent 22: 251–257

    PubMed  Google Scholar 

  99. Matsuura M, Ohno K, Michi K, Egawa K, Takiguchi R (1999) Clinicoanatomic examination of the fibula: anatomic basis for dental implant placement. Int J Oral Maxillofac Implants 14: 879–884

    CAS  PubMed  Google Scholar 

  100. Meagher PJ, Morrison WA (2002) Free fibula flap-donor-site morbidity: case report and review of the literature. J Reconstr Microsurg 18: 465–468

    Article  PubMed  Google Scholar 

  101. Minami A, Usui M, Ogino T, Minami M (1986) Simultaneous reconstruction of bone and skin defects by free fibular graft with a skin flap. Microsurgery 7: 38–45

    CAS  PubMed  Google Scholar 

  102. Minami A, Kaneda K, Itoga H, Usui M (1989) Free vascularized fibular grafts. J Reconstr Microsurg 5: 37–43

    CAS  PubMed  Google Scholar 

  103. Minami A, Kato H, Suenaga N, Iwasaki N (1999) Distally-based free vascularized tissue grafts in the lower leg. J Reconstr Microsurg 15: 495–499

    CAS  PubMed  Google Scholar 

  104. Monaghan AM, Dover MS (2002) Assessment of free fibula flaps: a cautionary note. Br J Oral Maxillofac Surg 40: 258–259

    Article  CAS  PubMed  Google Scholar 

  105. Munoz Guerra MF, Gias LN, Rodriguez Campo FJ, Diaz Gonzalez FJ (2001) Vascularized free fibular flap for mandibular reconstruction: a report of 26 cases. J Oral Maxillofac Surg 59: 140–144

    Article  PubMed  Google Scholar 

  106. Nagoya S, Usui M, Wada T, Yamashita T, Ishii S (2000) Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours. J Bone Joint Surg Br 82: 1121–1124

    Article  CAS  PubMed  Google Scholar 

  107. Nakayama B, Matsuura H, Hasegawa Y, Ishihara O, Hasegawa H, Torii S (1994) New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap. Br J Plast Surg 47: 247–249

    CAS  PubMed  Google Scholar 

  108. Newington DP, Sykes PJ (1991) The versatility of the free fibula flap in the management of traumatic long bone defects. Injury 22: 275–281

    Article  CAS  PubMed  Google Scholar 

  109. Ng RL, Beahm E, Clayman GL, Hassenbusch SJ, Miller MJ (2002) Simultaneous reconstruction of the posterior pharyngeal wall and cervical spine with a free vascularized fibula osteocutaneous flap. Plast Reconstr Surg 109: 1361–1365

    Article  PubMed  Google Scholar 

  110. Nichols PT, Wilson EP (1999) Fibula free flap reconstruction of composite oromandibular defects. W V Med J 95: 302–304

    CAS  PubMed  Google Scholar 

  111. Nocini PF, Wangerin K, Albanese M, Kretschmer W, Cortelazzi R (2000) Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report. J Craniomaxillofac Surg 28: 20–24

    Article  CAS  PubMed  Google Scholar 

  112. Nocini PF, De Santis G, Bedogni A, Chiarini L (2002) Simultaneous bimaxillary alveolar ridge augmentation by a single free fibular transfer: a case report. J Craniomaxillofac Surg 30: 46–53

    Article  CAS  PubMed  Google Scholar 

  113. Nonnenmacher J, Bahm J, Moui Y (1995) The free vascularized fibular transfer as a definitive treatment in femoral septic non-unions. Microsurgery 16: 383–387

    CAS  PubMed  Google Scholar 

  114. O’Brien BM, Gumley GJ, Dooley BJ, Pribaz JJ (1988) Folded free vascularized fibula transfer. Plast Reconstr Surg 82: 311–318

    CAS  PubMed  Google Scholar 

  115. O’Leary MJ, Martin PJ, Hayden RE (1994) The neurocutaneous free fibula flap in mandibular reconstruction. Otolaryngol Clin North Am 27: 1081–1096

    CAS  PubMed  Google Scholar 

  116. Olvera-Caballero C (2000) Mandibular reconstruction in children. Microsurgery 20: 158–161

    Article  CAS  PubMed  Google Scholar 

  117. Ozaki T, Hillmann A, Wuisman P, Winkelmann W (1997) Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors. Acta Orthop Scand 68: 298–301

    CAS  PubMed  Google Scholar 

  118. Papadopulos NA, Schaff J, Biemer E (2001) Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction. J Reconstr Microsurg 17: 407–412

    Article  CAS  PubMed  Google Scholar 

  119. Papadopulos NA, Schaff J, Biemer E (2002) Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm or fibula flap in 18 female-to-male transsexuals. Plast Reconstr Surg 109: 1025–1030

    Article  PubMed  Google Scholar 

  120. Papadopulos NA, Schaff J, Bucher H, Groener R, Geishauser M, Biemer E (2002) Donor site morbidity after harvest of free osteofasciocutaneous fibular flaps with an extended skin island. Ann Plast Surg 49: 138–144

    Article  PubMed  Google Scholar 

  121. Pederson WC (2001) Upper extremity microsurgery. Plast Reconstr Surg 107: 1524–1537

    Article  CAS  PubMed  Google Scholar 

  122. Pelissier P, Boireau P, Martin D, Baudet J (2003) Bone reconstruction of the lower extremity: complications and outcomes. Plast Reconstr Surg 111: 2223–2229

    Article  PubMed  Google Scholar 

  123. Posnick JC, Wells MD, Zuker RM (1993) Use of the free fibular flap in the immediate reconstruction of pediatric mandibular tumors: report of cases. J Oral Maxillofac Surg 51: 189–196

    CAS  PubMed  Google Scholar 

  124. Reychler H, Iriarte Ortabe J (1994) Mandibular reconstruction with the free fibula osteocutaneous flap. Int J Oral Maxillofac Surg 23: 209–213

    CAS  PubMed  Google Scholar 

  125. Reychler H, Iriarte Ortabe J, Pecheur A, Brogniez V (1996) Mandibular reconstruction with a free vascularized fibula flap and osseointegrated implants: a report of four cases. J Oral Maxillofac Surg 54: 1464–1469

    CAS  PubMed  Google Scholar 

  126. Reychler H, Iriarte Ortabe J, Lambert F (1997) Bilateral mandibular angle reconstruction with a single free vascularized fibula flap. Plast Reconstr Surg 99: 1411–1414

    CAS  PubMed  Google Scholar 

  127. Rinaldo A, Shaha AR, Wei WI, Silver CE, Ferlito A (2002) Microvascular free flaps: a major advance in head and neck reconstruction. Acta Otolaryngol 122: 779–784

    Article  PubMed  Google Scholar 

  128. Rohner D, Bucher P, Kunz C, Hammer B, Schenk RK, Prein J (2002) Treatment of severe atrophy of the maxilla with the prefabricated free vascularized fibula flap. Clin Oral Implants Res 13: 44–52

    Article  PubMed  Google Scholar 

  129. Roumanas ED, Markowitz BL, Lorant JA, Calcaterra TC, Jones NF, Beumer J (1997) Reconstructed mandibular defects: fibula free flaps and osseointegrated implants. Plast Reconstr Surg 99: 356–365

    CAS  PubMed  Google Scholar 

  130. Ruch DS, Koman LA (1997) The fibula-flexor hallucis longus osteomuscular flap. J Bone Joint Surg Br 79: 964–968

    Article  CAS  PubMed  Google Scholar 

  131. Sadove RC, Sengezer M, McRoberts JW, Wells MD (1993) One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg 92: 1314–1323

    CAS  PubMed  Google Scholar 

  132. Saleem M, Hashim F, Babu Manohar M (1998) Compartment syndrome in a free fibula osteocutaneous flap donor site. Br J Plast Surg 51: 405–407

    Article  CAS  PubMed  Google Scholar 

  133. Santamaria E, Wei FC, Chen HC (1998) Fibula osteoseptocutaneous flap for reconstruction of osteoradionecrosis of the mandible. Plast Reconstr Surg 101: 921–929

    CAS  PubMed  Google Scholar 

  134. Santanelli F, Latini C, Leanza L, Scuderi N (1996) Combined radius and ulna reconstruction with a free fibula transfer. Br J Plast Surg 49: 178–182

    Article  CAS  PubMed  Google Scholar 

  135. Schoeller T, Wechselberger G, Meirer R, Bauer T, Piza-Katzer H, Ninkovic M (2002) Functional osteomuscular free-tissue transfer: the reinnervated fibula-flexor hallucis longus free flap. Plast Reconstr Surg 109: 253–257

    PubMed  Google Scholar 

  136. Schuind F, Burny F, Lejeune FJ (1988) Microsurgical free fibular bone transfer: a technique for reconstruction of large skeletal defects following resection of high-grade malignant tumors. World J Surg 12: 310–317

    CAS  PubMed  Google Scholar 

  137. Schusterman MA, Reece GP, Miller MJ, Harris S (1992) The osteocutaneous free fibula flap: is the skin paddle reliable? Plast Reconstr Surg 90: 787–793

    CAS  PubMed  Google Scholar 

  138. Schusterman MA, Reece GP, Miller MJ (1993) Osseous free flaps for orbit and midface reconstruction. Am J Surg 166: 341–345

    CAS  PubMed  Google Scholar 

  139. Seres L, Csaszar J, Voros E, Borbely L (2001) Donor site angiography before mandibular reconstruction with fibula free flap. J Craniofac Surg 12: 608–613

    Article  CAS  PubMed  Google Scholar 

  140. Serletti JM, Coniglio JU, Tavin E, Bakamjian VY (1998) Simultaneous transfer of free fibula and radial forearm flaps for complex oromandibular reconstruction. J Reconstr Microsurg 14: 297–303

    CAS  PubMed  Google Scholar 

  141. Sharma S, Tiwari P, Kasabian AK, Longaker MT (2000) Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula. Ann Plast Surg 45: 202–206

    CAS  PubMed  Google Scholar 

  142. Shindo M, Fong BP, Funk GF, Karnell LH (2000) The fibula osteocutaneous flap in head and neck reconstruction: a critical evaluation of donor site morbidity. Arch Otolaryngol Head Neck Surg 126: 1467–1472

    CAS  PubMed  Google Scholar 

  143. Shiraishi H, Fujii S, Kobayashi R (2002) Function of the upper extremity and ability to perform housework following reconstructive surgery of the shoulder joint using a free vascularized fibula bone graft: a case report. J Hand Ther 15: 274–281

    PubMed  Google Scholar 

  144. Shpitzer T, Neligan P, Boyd B, Gullane P, Gur E, Freeman J (1997) Leg morbidity and function following fibular free flap harvest. Ann Plast Surg 385: 460–464

    Google Scholar 

  145. Shpitzer T, Neligan PC, Gullane PJ, Freeman JE, Boyd BJ, Rotstein LE, Brown DH, Irish JC, Gur E (1997) Oromandibular reconstruction with the fibular free flap. Analysis of 50 consecutive flaps. Arch Otolaryngol Head Neck Surg 123: 939–944

    CAS  PubMed  Google Scholar 

  146. Siciliano S, Lengele B, Reychler H (1998) Distraction osteogenesis of a fibula free flap used for mandibular reconstruction: preliminary report. J Craniomaxillofac Surg 26: 386–390

    CAS  PubMed  Google Scholar 

  147. Smith RB, Funk GF (2003) Severe trismus secondary to periosteal osteogenesis after fibula free flap maxillary reconstruction. Head Neck 25: 406–411

    Article  PubMed  Google Scholar 

  148. Smith RB, Thomas RD, Funk GF (2003) Fibula free flaps: the role of angiography in patients with abnormal results on preoperative color flow Doppler studies. Arch Otolaryngol Head Neck Surg 129: 712–715

    Article  PubMed  Google Scholar 

  149. Store G, Boysen M, Skjelbred P (2002) Mandibular osteoradionecrosis: reconstructive surgery. Clin Otolaryngol. 27: 197–203

    Google Scholar 

  150. Strackee SD, Kroon FH, Bos KE (2001) Fixation methods in mandibular reconstruction using fibula grafts: a comparative study into the relative strength of three different types of osteosynthesis. Head Neck 23: 1–7

    Article  CAS  Google Scholar 

  151. Strackee SD, Kroon FH, Jaspers JE, Bos KE (2001) Modeling a fibula transplant in mandibular reconstructions: evaluation of the effects of a minimal number of osteotomies on the contour of the jaw. Plast Reconstr Surg 108: 1915–1921

    Article  CAS  PubMed  Google Scholar 

  152. Takami H, Takahashi S, Ando M, Masuda A (1997) Vascularized fibular grafts for the reconstruction of segmental tibial bone defects. Arch Orthop Trauma Surg 116: 404–407

    Article  CAS  PubMed  Google Scholar 

  153. Takushima A, Harii K, Asato H, Nakatsuka T, Kimata Y (2001) Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases. Plast Reconstr Surg 108: 1555–1563

    Article  CAS  PubMed  Google Scholar 

  154. Taylor GI (1977) Microvascular free bone transfer: a clinical technique. Orthop Clin North Am 8: 425–447

    CAS  PubMed  Google Scholar 

  155. Taylor GI, Miller GD, Ham FJ (1975) The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 55: 533–544

    CAS  PubMed  Google Scholar 

  156. Toh S, Harata S, Ohmi Y, Nakahara K, Satoh F, Tsubo K, Nakamura R, Nishikawa S (1988) Dual vascularized fibula transfer on a single vascular pedicle: a useful technique in long bone reconstruction. J Reconstr Microsurg 4: 217–221

    CAS  PubMed  Google Scholar 

  157. Triana RJ Jr, Uglesic V, Virag M, Varga SG, Knezevic P, Milenovic A, Aljinovic N, Murakami CS, Futran ND (2000) Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg 2: 91–101

    Article  PubMed  Google Scholar 

  158. Turk JB, Vuillemin T, Raveh J (1994) Revascularized bone grafts for craniofacial reconstruction. Otolaryngol Clin North Am 27: 955–982

    CAS  PubMed  Google Scholar 

  159. Twisk R van, Pavlov PW, Sonneveld J (1988) Reconstruction of bone and soft tissue defects with free fibula transfer. Ann Plast Surg 21: 555–558

    PubMed  Google Scholar 

  160. Wada T, Usui M, Isu K, Yamawakii S, Ishii S (1999) Reconstruction and limb salvage after resection for malignant bone tumour of the proximal humerus. A sling procedure using a free vascularised fibular graft. J Bone Joint Surg Br 81: 808–813

    Article  CAS  PubMed  Google Scholar 

  161. Watson JT, Anders M, Moed BR (1995) Management strategies for bone loss in tibial shaft fractures. Clin Orthop 315: 138–152

    PubMed  Google Scholar 

  162. Wax MK, Winslow CP, Hansen J, MacKenzie D, Cohen J, Andersen P, Albert T (2000) A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap. Laryngoscope 110: 977–981

    Article  CAS  PubMed  Google Scholar 

  163. Wei FC, El-Gammal TA (1997) Free vascularized bone grafts and osteocutaneous flaps. In: Georgiade G, Riefkohl R (eds) Plastic, maxillofacial and reconstructive surgery, 3rd edn. Williams & Wilkins, Baltimore, pp 940–945

  164. Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS (1994) Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg 93: 294–304

    CAS  PubMed  Google Scholar 

  165. Wei FC, El Gammal TA, Lin CH, Ueng WN (1997) Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects. J Trauma 43: 784–792

    CAS  PubMed  Google Scholar 

  166. Wei FC, Santamaria E, Chang YM, Chen HC (1997) Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants. J Craniofac Surg 8: 512–521

    CAS  PubMed  Google Scholar 

  167. Wei FC, Demirkan F, Chen HC, Chen IH (1999) Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg 103: 39–47

    CAS  PubMed  Google Scholar 

  168. Wei FC, Celik N, Chen HC, Cheng MH, Huang WC (2002) Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 109: 45–52

    PubMed  Google Scholar 

  169. Winters HA, Jongh GJ de (1999) Reliability of the proximal skin paddle of the osteocutaneous free fibula flap: a prospective clinical study. Plast Reconstr Surg 103: 846–849

    CAS  PubMed  Google Scholar 

  170. Wolff KD, Ervens J, Herzog K, Hoffmeister B (1996) Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Craniomaxillofac Surg 24: 330–338

    CAS  PubMed  Google Scholar 

  171. Wood MB (1986) Free vascularized bone transfers for nonunions, segmental gaps, and following tumor resection. Orthopedics 9: 810–816

    CAS  PubMed  Google Scholar 

  172. Yajima H, Tamai S (1994) Twin-barreled vascularized fibular grafting to the pelvis and lower extremity. Clin Orthop 303: 178–184

    PubMed  Google Scholar 

  173. Yim KK, Wei FC (1994) Fibula osteoseptocutaneous flap for mandible reconstruction. Microsurgery 15: 245–249

    CAS  PubMed  Google Scholar 

  174. Yoshimura M, Shimamura K, Iwai Y, Yamauchi S, Ueno T (1983) Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula. J Bone Joint Surg Am 65: 1295–1301

    CAS  PubMed  Google Scholar 

  175. Youdas JW, Wood MB, Cahalan TD, Chao EY (1988) A quantitative analysis of donor site morbidity after vascularized fibula transfer. J Orthop Res 6: 621–629

    CAS  PubMed  Google Scholar 

  176. Zimmermann CE, Borner BI, Hasse A, Sieg P (2001) Donor site morbidity after microvascular fibula transfer. Clin Oral Invest 5: 214–219

    Article  CAS  Google Scholar 

  177. Zlotolow IM, Huryn JM, Piro JD, Lenchewski E, Hidalgo DA (1992) Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibula free flap reconstructed mandibles. Am J Surg 164: 677–681

    CAS  PubMed  Google Scholar 

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  1. Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    D. Erdmann, G. E. O. Bergquist, W. Bruno, H. Young & L. S. Levin

  2. Section Plastic Surgery, VA Medical Center, Durham, NC, USA

    D. Erdmann

  3. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie—Schwerbrandverletztenzentrum—, BG-Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg

    G. A. Giessler & C. Heitmann

  4. Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Box 3181, Durham, NC 27710 , USA

    D. Erdmann

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Erdmann, D., Giessler, G.A., Bergquist, G.E.O. et al. Freier Fibulatransfer. Chirurg 75, 799–809 (2004). https://doi.org/10.1007/s00104-004-0833-9

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