Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience.

The International Journal of Oral & Maxillofacial Implants Reconstruction of maxillofacial defects is a complex task involving replacement of hard and soft tissue as well as reestablishment of oral function and facial esthetics. Microvascular techniques allow for reliable reconstruction of complex bone and soft tissue defects in both arches. For the treatment of defects involving extended parts of the jaws, the most frequently used donor sites are the fibula and the iliac crest, with the final goal of reestablishing contour, function, and esthetics.1–5 Conventional reconstruction of jaw defects is achieved using free vascularized osseous, osteocutaneous, or osteomyocutaneous flaps. The primary aim is simply to transfer vital tissue into the defect. For functional rehabilitation, shaping and debulking are necessary, often over the course of several procedures.6–8 Finally, dental implants are placed. The period between flap inset and definitive prosthetic rehabilitation may be very uncomfortable for the patient and may even prevent normal social contact. The major change in the authors’ technique was to reverse the workflow of treatment, beginning with the prospective endpoint of the reconstruction. Inspired by the work of Vinzenz et al,9 the authors developed a protocol for prefabricating not only the mucosa but also the new occlusion and the entire implant-bearing alveolar process. It was hoped that this protocol would result in early functional rehabilitation, independent of the size or location of the defect. Since the early 1990s, the fibula has been the authors’ preferred vascularized bone graft for reconstruction of mandibular as well as maxillary defects, so their prefabrication technique is tailored to fibular grafts. However, it can be adapted to other vascularized bone areas. 1 Associate Professor, Craniofacial Center, Hirslanden Medical Center, Aarau, Switzerland. 2 Technician, Craniofacial Center, Hirslanden Medical Center, Aarau, Switzerland. 3 Professor, Craniofacial Center, Hirslanden Medical Center, Aarau, Switzerland.