What is a fibula flap transfer?

The fibula is a long, thin bone of the outer leg alongside the shinbone. It is sometimes used to harvest bone that can be used in certain reconstructive surgeries of bone. The fibula can be removed without impacting the individual’s ability to walk or bear weight.

Conditions that cause bony defects where fibula bone can be used in repair:

The fibula flap transfer procedure is often the preferred option for repair of these conditions. Before the advent of the fibula flap in the mid-seventies, people with bony defects in their jaw suffered difficulties in chewing, swallowing and speaking, in addition to cosmetic defects.

Who needs fibula flap surgery?

People with bony defects may require fibula flap surgery. This surgery may be helpful in the following:

  • Cancer involving bone
  • Injuries involving the bone
  • Birth defects of bone
  • Dental reconstruction
  • As a part of other cosmetic surgeries

How is fibula flap surgery performed?

Fibula flap surgery is generally performed by a plastic surgeon with the patient under general anesthesia.

Preparation

The patient may be required to

  • Undergo blood tests.
  • Undergo imaging studies (CT scan), angiography, etc.
  • Avoid eating and drinking for eight hours before the procedure.
  • Discuss medications that need to be taken before the surgery with the doctor.
  • Discuss allergies and other diseases with the doctor.

During the procedure

  • The anesthesiologist administers general IV anesthesia.
  • They will also monitor the patient’s vital signs during the procedure.
  • The surgeon makes an incision on the leg.
  • A section of the fibula bone (the flap) is removed along with blood vessels.
  • The flap is harvested ensuring that segments of bone remain in the leg to ensure that the patient can walk and bear weight.
  • The leg incision is closed with sutures.
  • The flap is transferred to the prepared site and secured in position with small plates and screws.
  • The surgeon joins the blood vessels in the flap to the blood vessels in the patient’s prepared reception site under a microscope.
  • Suction drains are placed in the neck with sutures.
  • A feeding tube may be placed if needed.
  • The surgeon closes the incisions with sutures.

After the procedure

  • The patient’s vital signs are monitored.
  • The patient is weaned off the anesthesia and painkillers, antibiotics and other required medications are administered.
  • The donor and recipient flap sites are observed for any abnormal swelling, color change or bleeding.

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How long is the recovery after fibula flap surgery?

Generally, recovery after fibula flap surgery takes three to four weeks and includes 10 to 14 days in the hospital.

  • The patient may move in a no weight-bearing fashion on the second postoperative day.
  • The splint is removed and the skin graft is assessed on the fifth postoperative day.
  • The patient is then allowed to walk with the help of a walker or other assistive devices.
  • If a skin graft and splint were not used in the surgery, the patient is typically allowed to bear weight on the second postoperative day.
  • The patient is generally asked to visit the doctor one to two weeks after being discharged from the hospital.

Are there any complications with fibula flap surgery?

The complications with fibula flap surgery are:

  • Loss of flap
  • Problems connecting the fibula bone with the bone at the receiving site
  • Fistula (an abnormal tunnel or passage that connects the skin to the tissues underneath)
  • Hematoma (swelling of clotted blood under the tissues)
  • Wound rupture
  • Bleeding
  • Pain
  • Nerve injury
  • Scarring
  • Facial asymmetry
  • Infection
  • Ankle instability
  • Swelling

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Medically Reviewed on 6/19/2020
References
Medscape Medical Reference

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