Preplating, plate removal, resection, replating, template modelling, contouring and fixation of the fibula represent the key points of the procedure. Novel surgical techniques in female to male gender. Conveys information on all important issues in the surgical procedure, including the use of cadcam technology, bone synthesis and flap modelling. The term phalloplasty is also occasionally used to refer to penis enlargement the first phalloplasty done for the purposes of sexual reassignment was performed on michael dillon, a trans man, in 1946 by dr. The latter team harvested the flap according to the principles described by hidalgo.
With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2 nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Primary disease, type of reconstruction, defect area, fibula segment length and number of. Vascularized fibula graft for humeral reconstruction. Stepbystep mandibular reconstruction with free fibula. Conveys information on all important issues in the surgical procedure, including the use of cadcam technology, bone synthesis and flap. This paper describes a simplified technique for primary reconstruction of mandibular defects, including. Free fibula flow through osteocutaneous flap in the upper extremity sarcoma reconstruction. In spiral or oblique fracture patterns, a clamp can be applied for reduction. In general, a bka is preferred over an aboveknee amputation aka, as the former has better rehabilitation and functional outcomes. Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. However, little is published about its role in reconstructing the mandibular condyle. The surgical technique is discussed in a stepbystep fashion.
A belowknee amputation bka is a transtibial amputation that involves removing the foot, ankle joint, and distal tibia and fibula with related soft tissue structures. Stepbystep surgical technique for mandibular reconstruction with fibular free flap. Free vascularized fibula flap alpha hand surgery centre. Osteocutaneous flap an overview sciencedirect topics. The aim of this study was to describe and evaluate surgical navigationassisted mandibular reconstruction with the fibula flap. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while. European archives of otorhinolaryngology, 272 6, 14911501.
A long segment of bone up to approximately 22 cm is available for harvest. The aim of this study was to evaluate the accuracy of computerassisted surgery in primary mandibular reconstruction with an iliac crest bone flap compared with an osteomyocutaneous fibula flap. Watch surgeons perform procedures in real time with an unparalleled twohour video collection that demonstrates harvest of the fibula flap for use in mandible reconstruction, the jejunum for esophagus reconstruction, and the siea, diep and igap flaps for breast reconstruction functioning muscle transfers for a variety of defects, including the gracilis muscle for facial reanimation and the gracilis musculocutaneous flap. In paediatric patients, the fvff is used chiefly for bone defects due to a tumour, infection, or trauma, although other indications include congenital pseudarthrosis of the tibia and. This is a result of various factors, such as improved preoperative examination methods, appropriate patient and donorsite selection, advancement in surgical techniques and instruments, and surgeons increasing experiences with microsurgery.
Surgical technique zmost common surgical techniques are. First video of a two part presentation on the technique of fibula flap osteotomy. Fibula flap harvest the patient is placed in the supine position with a bump under the ipsilateral hip to lessen the need for excessive internal rotation of the lower leg. It can be harvested as a purely osseus flap or can include a large fasciocutaneous component if needed. The illuminoss implant can be used for either the left or the right fibula. This atlas deals with the standard technique used for reconstructing the mandible and the maxilla the fibula flap. The reader will find useful information on all issues that are important in the surgical procedure, including the use of cadcam technology computer assisted technology, bone synthesis and flap modelling.
Mandibular reconstruction with a fibular free flap fff is currently considered the best choice for functional and aesthetic rehabilitation after oncological surgery. Donor leg morbidity and function after fibula free flap mandible. Transfer of a free vascularised fibular flap fvff is an option for treating bone defects of 5 cm or more in children. The fibula free flap approach allows the possibility of using bone withwithout skin for restoring the defect. However, the fibula and the upper leg are the most common donor sites for free flap tissues. The fibula s anatomy lends itself to this procedure, where the bone is long and straight, and its vascular supply is radially directed.
This book includes complimentary access to a digital copy. It is critical that fibular length, alignment and rotation are accurately restored. Ten distally based peroneus brevis muscle flaps were elevated in 10 patients 8 males and 2 females with major lower third leg and ankle defects that were 612 cm in length and 610 cm in width, with open book splitting of the proximal portion of the muscle. Repositioning template for mandibular reconstruction with. Fibula osteocutaneous free flap dissection surgical video.
In order to reduce overall operation time, surgery was performed using two teams. Patients recruited into the study had a custom dental splint fabricated to maintain the mandible in a fixed position. Long posterior flap a burgess technique b bruckner technique 2. When harvesting an osteocutaneous flap, the posterolateral skin incision is now made down to the fascia and a subfascial elevation of the skin from the soleus muscle is made. In this video, the technique is demonstrated on a 3d model of the fibula flap. The main goal of metoidioplasty is to give the patient malelooking genitalia and the possibility to void in standing position. The fibula free flap provides a long, strong segment of bone for use in reconstructive surgery. The peroneus brevis muscle flap is a wellknown distally based safe flap that is used to cover a small defect. Osteocutaneous fibula free flap iowa head and neck protocols. If you are a seller for this product, would you like to suggest updates through seller support. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, preoperative virtual planning, construction of cutting guides and customized laser prebent titanium plates. Innervation of the flap is possible, and the flap has ample bone stock for the placement. Metoidioplasty is one of the most popular surgical techniques for creating neophallus in female transsexuals.
This document is intended as an outline for the surgical technique of the repair of the fibula. Openbook splitting of a distally based peroneus brevis. Later, the computed tomography ct scan, preoperative design. Watch surgeons perform procedures in real time with an unparalleled twohour video collection that demonstrates harvest of the fibula flap for use in mandible reconstruction, the jejunum for esophagus reconstruction, and the siea, diep and igap flaps for breast reconstruction functioning muscle transfers for a variety of defects, including the gracilis muscle for facial reanimation and the gracilis musculocutaneous flap for finger flexion reconstruction with innervation using the. Long posterior flap burgess technique zdesigned by kendrick 1956 and made popular by burgess 1969. The fvff technique was first developed by taylor et al. Atlas of mandibular and maxillary reconstruction with the. About book this atlas deals with the standard technique used for reconstructing the mandible and the maxilla the fibula flap. Adequate assessment of the mandible for invasion by primary tumours of the oral cavity is crucial to accurate surgical treatment planning. Harold gillies, which is documented in pagan kennedys book. With the advent of lower profile fracturespecific implants and minimally invasive surgical techniques mis, wound complications may be mitigated. Surgical navigationassisted mandibular reconstruction. Here, we aimed to establish the preplating technique for oromandibular reconstruction in a stepbystep fashion, based on 41 patients. Minimally invasive surgical approach to distal fibula.
Free vascularised fibular flap harvesting in children. Whenever surgery is required to remove a tumor from ones body, free flap surgery fills the space that was the tumor once occupied. The fibula osteocutaneous free flap is arguably the workhorse bone flap for both maxillary and mandibular reconstruction. Experimental flap surgery aims to increase our understanding of flap physiology and to test new surgical techniques to increase flap viability. Vascularized fibula graft is a good option for large humeral defects resulting from trauma, tumor resection, or infection and for smaller defects where enhanced blood supply is necessary for healing. Preplating, plate removal, resection, replating, template modelling, contouring and fixation of the fibula. A senior surgeon did the planning, flap harvesting.
Several authors have previously reported minimally invasive techniques to address distal fibula fractures, although most achieved fixation without anatomic reduction of the fracture site 611. Original article by journal of evolution of medical and dental sciences. Documenting in unprecedented detail the surgical procedures, techniques, and approaches used by the experts, this new atlastext is the definitive fullcolor pictorial reference on major flap. The technique for implantation in fibula flap is very similar to the technique in native mandible but access to the bone is the most difficult step of the surgery. Application of digital technology in virtual surgical planning. Most commonly used experimental flaps used in rats, including dorsal skin, flank, epigastric, oblique groin, pectoral, latissimus. Many experimental flap models have been described with the advancement of flap surgery and research. In this article, we will discuss the details of free flap surgery microvascular and how free flap. The fibula flap has been used extensively for oromandibular reconstruction. The objective of this study was to evaluate a surgical technique and to present the results of delayed reconstruction of palatomaxillary defects using fibula free flap fff.
Below knee amputation bka statpearls ncbi bookshelf. Full text of stepbystep mandibular reconstruction with. Atlas of microsurgical composite tissue transplantation. The reader will find useful information on all issues that are important in the. Free fibula flow through osteocutaneous flap in the upper. The pedicle runs the length of the fibula, with perforators extending to supply the skin paddle. The skin paddle has proven to be dependable if care is taken to preserve the fasciocutaneous perforators. The fibula is the longest bone flap available and can be transferred as a bone flap or in combination with one or two skin paddles. Its indicational spectrum, therefore, reaches from bony reconstruction at the extremities to replacement of the whole mandible, including closure of large perforating defects of the oral cavity. Phalloplasty is the construction or reconstruction of a penis, or the artificial modification of the penis by surgery.
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