The medial approach to the fibula: a feasible alternative

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
Felix BlakeLei Li

Abstract

Since the first harvesting of a microsurgical fibula in 1974 by Ueba and in 1975 by Taylor, using the fibula for osseous reconstruction has proven to be a valuable approach. The harvesting technique, which has been refined by subsequent investigators, has become increasingly standardized, today providing a clear, reproducible method. The procedure involves elevating the fibular graft from lateral, choosing the shortest route to reach the fibula. One disadvantage of this approach is that the bone often obstructs visualization of the vascular pedicle, which lies medially, promoting unintentional injury. In addition, this method is associated with some donor site morbidity, prompting further investigations into accessing the fibula. Here we present an alternative approach for harvesting the fibula and highlight the pros and cons of each approach. Between 1999 and 2006, a total of 38 microsurgical (23 for the mandible, 9 for the extremities, and 6 for the maxilla) fibula grafts were harvested through the medial approach. In all cases, the patency of the posterior tibial, peroneal vessels, and the tibial nerve could be visualized. Two flaps failed (both mandible, for a success rate of 94.7%). No ischemic or wound healing complicatio...Continue Reading

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Citations

May 21, 2010·Current Opinion in Otolaryngology & Head and Neck Surgery·Brett A MilesPatrick J Gullane
Jan 3, 2012·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Philip Catalá-LehnenFelix Blake
Mar 15, 2011·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Klaus D WolffMarco R Kesting
May 2, 2009·The British Journal of Oral & Maxillofacial Surgery·Yuxiao LiuXianjun Lin
Jan 10, 2017·The British Journal of Oral & Maxillofacial Surgery·J S BrownA Schache
May 11, 2019·Microsurgery·Sarah M ElswickSalvatore C Lettieri
Feb 10, 2018·The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS·Stefan RaithAli Modabber

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