One and a Half Barrel Vascularized Free Fibular Flap for the Reconstruction of Segmental Mandibular Defect: A Case Report

PURPOSE

One of the most appropriate option for reconstruction of segmental mandibular defect is the vascularized free fibular flap. However, difference in height between mandible and fibula causes aesthetic and functional problems. Even if we tried to overcome these problems by some modifications such as an additional reconstruction plate along the lower border of the mandible in combination with a higher placement of fibula, lack of a flap wide enough to completely fill the mandibular defect is an important disadvantage for us. The double barrel free vascularized fibular flap has been useed to eliminate this disadvantage, but this flap is too large for especially alveolar bone reconstruction. Lee et al. have used pieces of non-vascularized residual fibula as graft for simulate the superior alveolar mandible in addition to vascularized fibula flap. However, the most important drawback of this technique is the use of avascularized bone graft to repair a large defect.

We designed one and a half barrel vascularized free fibular flap to overcome the disadvantages of both techniques for reconstruction of mandibular defects.

MATERIALS AND METHODS

Eight centimeter length mandibular body segment was excised because of giant cell reparative granuloma diagnosis. Vascularized fibular flap was harvested and shaped as follows. A small piece of bone (segment B) was removed at the middle of the flap to fold the flap. The distal half of the flap had been splitted longitidunally, and the bone segment away from the perforator vessels (segment D) were removed.

 And then two remaining fibula segments were folded, and placed in parallel to each other in the defect.

 

RESULTS

The flap has survived and no major complication was observed. Flap viability has been shown in bone scintigraphy. Radiography revealed bone healing between the transplanted fibula and native mandible. Osseointegrated dental implantation is planned.  

CONCLUSIONS

One and a half barrel technique may be a good solution for incompatibility of the sizes of the segmental mandibular defect and the vascularized fibula flap. This technique eliminates volume insufficiency of the classical technique, and volume excess of the double-barrel technique. One and a half vascularized fbula flap perfect fit for mandibular defect, and we think that would allow us to placement of osseointegrated dental implants.