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Fibular osteocutaneous free tissue transfer represents state-of-the-art reconstruction of the oromandibular complex after oncologic resection. Because the blood supply of the fibular flap is based on the peroneal artery and venae comitantes, it is essential to determine preoperatively whether adequate perfusion to the donor extremity will persist after sacrifice of the peroneal pedicle. Vascular variations or peripheral arterial occlusive disease may exist whereby sacrifice of peroneal vessels can cause ischemia of the lower leg and foot. Therefore, angiography of the lower extremity and magnetic resonance angiography have been advocated to determine the arterial supply to the lower leg. Though accurate, these examinations carry risk for morbidity, and both are expensive. Color Doppler flow imaging is a noninvasive ultrasound examination used to measure antegrade and retrograde blood flow. We prospectively evaluated color Doppler flow imaging as a means of preoperative evaluation of the lower extremity for candidates for fibular flaps. Ability to image peroneal vessels and to determine collateral and distal perfusion were evaluated. The patients were compared with a control group of patients with peripheral arterial occlusive disease. Color Doppler flow imaging provided accurate hemodynamic information for all patients and allowed successful fibular transfer for all patients who received free flaps. The modality is comparable in accuracy with the angiography of the lower extremity and magnetic resonance angiography and has the advantages of low cost and no morbidity.

Fibula osseocutaneous free tissue transfer represents state-of-the-art reconstruction of the oromandibular complex following oncologic resection. The width of the fibula skin paddle is usually limited by the ability to achieve primary wound closure. In some cases the donor site requires skin grafting and subsequent surgical procedures to achieve effective closure, or placement of a tissue expander. The recent development of an indexed tissue advancement system (Sure Closure) makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in a single procedure. The system secures and brings together wound edges by applying graduated pressure with a metered force approximator. A series of 12 fibula osseocutaneous free flap defects is presented, which have been successfully closed using this simple, convenient, and safe device.

Objective: To evaluate the nature of complications and complication rates with the use of three different reconstruction plates for the rigid fixation of vascularized bone grafts in oromandibular reconstruction., Design: We conducted a case series of 95 patients over a 6-year period, with a minimum follow-up of 6 months and a maximum follow-up of 66 months., Setting: Academic tertiary referral medical center., Patients: Forty-eight patients had vascularized bone grafts fixated to native mandible with AO stainless steel reconstruction plates; 25 patients, with AO titanium plates; and 22 patients, with titanium hollow screw reconstruction plates (THORPs). Types of vascularized flaps, mandibular defects to be reconstructed, and use of radiation therapy were similar among the three groups., Intervention: The surgical approach involved oromandibular reconstruction with a vascularized bone graft rigidly fixated with a reconstruction plate., Outcome Measures: Clinically and radiographically noted complications and resultant treatment., Results: In the grafts fixated with AO stainless steel reconstruction plates, three plate fractures, seven instances of loose screws, eight plate exposures, and two cases of nonunion occurred. No cases of plate fracture or nonunion occurred in the titanium or THORP groups. One titanium plate and two THORPs were exposed during the study period. One instance of loose screws occurred in the titanium group; none in the THORP group. Seventy-four percent of those complications occurred within 12.4 months (the mean follow-up time of the THORP group). The incidence of complications in the stainless steel group was significantly greater than that in the titanium or THORP groups. No statistically significant increase in the rate of complications was noted when radiation therapy was used as a component of treatment., Conclusions: To our knowledge, this is the first study to compare three different reconstruction plates for fixation in vascularized bone reconstruction of the mandible. AO THORPs are now used almost exclusively to rigidly fixate vascularized bone grafts because of their advanced design and their potential for osseointegration and because fewer screws are necessary to attain adequate fixation than with conventional AO reconstruction plates.