Background  The flexor hallucis longus (FHL) muscle is crucial in fine motor control of the great toe but the muscle is often sacrificed in free fibula flap (FFF) reconstruction. The aim of this study was to compare great toe movement between complete and partial FHL resection during FFF harvest to see if FHL can be left behind (without undergoing fibrosis) in situ when bulk is not required at the recipient site. Methods  A prospective, cross-sectional, observational study was performed including patients undergoing FFF harvest over a 2-year period. Movement of great toe interphalangeal joint was recorded of operated and unoperated legs in patients undergoing partial and complete FHL harvest and data analyzed. Results  There was a statistically significant ( p  < 0.05) difference between the two groups of patients. Conclusion  FHL can be safely left in situ in patients not requiring bulk at the recipient site as blood supply, nerve supply, and muscle function are not compromised in partial FHL harvest. Further image-based and dye-based studies are warranted.

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OBJECTIVE: One stage functional jaw reconstruction is defined as the resection and reconstruction of segmental defects in conjunction with the placement of dental implants in an ideal prosthetic position and loaded with a provisional restoration, during one surgical procedure. The aim of the study is to describe clinical outcomes of patients who underwent one stage functional jaw reconstruction.
METHODS: Patients who underwent one-stage functional jaw reconstruction, from January 2013 to March 2016 were recalled in 2022 and 2023. Planning and execution for the reconstruction utilized either analogue or digital techniques. Outcome parameters recorded were treatment-related outcomes at patient level, implant-related outcomes and patient-reported outcome measures.
RESULTS: Eighteen patients underwent one-stage jaw reconstruction with a total of 57 implants. Four patients had maxillary and 14 had mandibular reconstructions. Ten patients underwent postoperative radiotherapy. Ten patients were planned using analogue and eight by digital planning. Three patients had partial flap necrosis, three patients had plate fractures, implant loss was seen in one patient and four patients died during the period. A functional prosthesis was provided in 16 out of the 18 patients.
CONCLUSIONS: One-stage functional jaw reconstruction is a predictable method for providing rehabilitation with successful outcomes at 7-11 years. However, caution should be exercised when the treatment modality is carried out in patients with malignant pathologies who have undergone radiotherapy.

UNASSIGNED: To evaluate and assess the indicators of bone metabolism markers osteocalcin and β-Cross-Laps in blood serum as a tool for monitoring bone regeneration and determining the time of implantation in patients after mandibulectomy and reconstruction of a free fibular flap with subsequent endosteal implants.
UNASSIGNED: Forty-eight patients in a 6-year period participated in this study, due to resection for tumors. All patients underwent reconstruction with fibula free flap after tumor resection, 4-6 months after osteoectomy, dental implants were installed with further orthopedic rehabilitation. To assess the rate of bone remodeling after transplantation, the content biochemical markers of bone remodeling osteocalcin and β-Cross-Laps serum were determined by enzyme immunoassay.
UNASSIGNED: All 46 fibular free flaps were healed without complications and were survived. A total 326 implants installed, 8 implants failed to osseointegrate, and 6 implants failed after 5 years of loading (peri-implantitis). Success rate of implants after 5 years was 95,7%. In patients before surgery, the mean of osteocalcin levels was 8.5 ng/ml, two months later, there was a sharp increase in the content of osteocalcin by 15.4 ng/ml, after four months reached 24.7 ng/ml, after six months of 28.6 ng/ml, then the indicator began to decrease and after 12 months it was approaching the norm of 14.7 ng/ml. In patients before surgery, the mean level of β-Cross-Laps was 0.76 ng/ml, after two months bone transplantation the mean level of β-Cross-Laps decreased to - 0.65 ng/ml, after four months the indicator increased and reached of 0.98 ng/ml, after six months the indicator was - 1.56 ng/ml, then these indicators began to decrease and after 12 months, approaching normal values of - 0.87 ng/ml. There is a correlation between different concentrations of osteocalcin or β-Cross- Laps and the success rate of implants. Implants were shown to be unsuccessful low concentrations of osteocalcin and high concentrations of β-Cross-Laps in serum.
UNASSIGNED: Studies have shown that the long-term survival and success rates of implants placed in the reconstructed areas may guarantee an excellent prognosis of implant-supported prostheses. Bone markers in blood serum osteocalcin and β-Cross-Laps can be used to evaluate the rate of bone remodeling, which allows you to determine the time of implantation.

UNASSIGNED: A systematic review of the literature on the donor site morbidity in patients undergoing Maxillofacial reconstruction was performed. The two widely used flaps namely free fibula flap (FFF) and DCIA flap were compared to answer the following questions: (1) Is donor site morbidity significantly different in patients undergoing maxillofacial reconstruction with FFF and DCIA flap? (2) Should donor site morbidity be considered as the criteria for choosing the flap for reconstruction.
UNASSIGNED: The search strategy was based on PRISMA guidelines. Various electronic databases were searched. On reviewing the seven articles included in our systematic review, we found out oral squamous cell carcinoma to be the most common pathology leading to the defects in head and neck region requiring reconstruction with free flaps.
UNASSIGNED: A total of 531 participants were investigated who underwent maxillofacial reconstruction using FFF and DCIA flap. The study included both the genders. The participants were assessed for short- and long-term donor site morbidity after the microvascular surgery. Mean age is 45-60 years. Three out of seven studies showed DCIA to have lesser complications at donor site than fibula group. While other two studies proved FFF to be better than DCIA. One study proved low donor site morbidity with regard to both the flap.
UNASSIGNED: The free fibula being the flap of choice in head and neck reconstruction has a comparable donor site morbidity to DCIA. The advantages of the iliac artery flap include natural curvature, abundant vertical and horizontal bone height for bone contouring and osseointegration, hidden scar, low incidence of wound healing problems and minimal effect on function and quality of life at long-term follow-up. Thus, it makes it the free flap of choice that one cannot avoid. This systematic review was registered at PROSPERO (CRD42021268949).

The free fibula flap (FFF), based on the peroneal artery (PA) system, is the gold standard for mandibular reconstruction. Various anatomical variations in the infra-popliteal lower limb vascular system exist. These variations present as an intraoperative surprise to surgeons even after an unremarkable clinical vascular examination of the leg. Here, we report one such case, where we performed successful mandibular reconstruction after encountering a Type IIIA variation of infra-popliteal arterial vasculature.

Intraoral dehiscence compromises free fibula flaps following mandibular reconstruction. Salivary contamination risks thrombosis of microvascular anastomosis and hardware infection. The superficial temporal artery islandized flap (STAIF) provides a non-microsurgical reconstructive option for regaining intraoral competency for a time-sensitive complication. The STAIF is based on the superficial temporal artery coursing along the anterior hairline. The flap is mapped with the assistance of the Doppler probe. The width of the skin paddle is dependent upon the ability to close the donor site. The flap is taken down to the level of the zygomatic arch and tunneled into the mouth. We present a case of a patient who underwent mandibular reconstruction with a free fibula flap after a traumatic shotgun wound. The patient developed repeated intraoral dehiscence following failed local buccal and floor of mouth flaps leading to salivary contamination of the flap and hardware. The intraoral dehiscence was successfully salvaged on the third attempt with a STAIF. Intraoral dehiscence requires urgent attention to prevent loss of the free fibula flap after mandibular reconstruction. The STAIF is a non-microsurgical option for restoring intraoral competency. This robust, axially vascularized skin paddle may be split for intra- and extraoral coverage, as was performed in this case, and is an essential tool in the reconstructive armamentarium.

Sternal non-union is a rare complication of median sternotomies following cardiac surgery. It results in sternal instability and is associated with a high rate of morbidity. Patients with sternal non-union usually complain of pain and sternal clicking with movement of the chest wall. Diagnosis is confirmed on computed tomography showing a gap between two sternal halves. Surgical correction of sternal instability is challenging. The key objective is to reconstruct a thoracic cage that allows for biomimesis and preserves normal physiologic cardiac and pulmonary functions all whilst achieving an aesthetically pleasing result. In this article, we describe a novel technique for sternal instability reconstruction using a triple-barrel vascularized free fibula flap fixed with rib titanium plates. This approach provides rigid long-lasting stability while preserving chest wall biomechanics.
La désunion sternale est une complication rare des sternotomies pour chirurgie cardiaque. Il en résulte une instabilité sternale responsable d’une morbidité élevée comme la douleur et le cliquetis lors des mouvements thoraciques. Le scanner confirme le diagnostic en montrant la solution de continuité entre les 2 moitiés du sternum. La reconstruction chirurgicale est complexe. Son but est de reconstruire une cage thoracique solide, permettant des fonctions cardiaque et respiratoire normales tout en assurant une esthétique satisfaisante. Nous décrivons ici une nouvelle technique de reconstruction sternale par lambeau libre fibulaire tripartitionné fixé par des plaques costales en titane. Elle permet une stabilisation pérenne de la cage thoracique et la restauration de sa mécanique.

OBJECTIVE: This study aims to establish a standardized, repeatable, and simple digital evaluation method for accurately determining the effect of computer-assisted free fibula mandibular reconstruction.
METHODS: A total of 20 mandibular defect cases caused by tumors were analyzed retrospectively. The coronal, sagittal, and axial mandibular angles were measured and analyzed with Mimics Research 21.0 and 3-matic Research 13.0 software before and after surgery. The effect of computer-assisted free fibula mandibular reconstruction was evaluated.
RESULTS: No significant difference was observed in the coronal and axial mandibular angles between the healthy and affected sides before operation (P>0.05). By contrast, a significant difference in sagittal mandibular angle (P<0.05) was noted. No significant difference was found in the coronal, sagittal, and axial mandibular angles between the healthy and affected sides after operation (P>0.05). Conversely, a significant difference was recorded in the absolute value of the coronal, sagittal, and axial mandibular angles between the healthy and affected sides pre-operation and post-operation (P<0.01). Meanwhile, a significant difference was observed in the sagittal mandibular angle between the healthy and affected sides before operation and the axial mandibular angle between the healthy and affected sides after operation in Type Ⅰ defect (P<0.05). Moreover, no significant difference in the 3D mandibular angle was found between the healthy and affected sides before and after operation in other types (P>0.05). Furthermore, no significant difference was recorded in the absolute values of the sagittal and coronal mandibular angles between the healthy and affected sides before and after operation in Type Ⅰ defect (P>0.05). Lastly, a significant difference was found in the absolute values of the 3D mandibular angles between the healthy and affected sides before and after operation in other types (P<0.05).
CONCLUSIONS: Computer-assisted free fibula mandibular reconstruction can significantly improve 3D mandibular deformities caused by tumors and effectively restore the accurate symmetry of the mandibular anatomical structure. The evaluation method used in this study can accurately evaluate the effects of mandibular reconstruction and provide guidance to preoperative design.
目的: 建立一种标准化、可重复、简易的数字化评估方法，精确评估计算机辅助游离腓骨下颌骨重建术后效果。方法: 通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析，在 Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向下颌角进行测量分析，评估计算机辅助游离腓骨下颌骨重建术后效果。结果: 在计算机辅助游离腓骨下颌骨重建的20例患者中，术前健侧和患侧冠状下颌角、轴向下颌角差异无统计学意义（P>0.05），矢状下颌角差异有统计学意义（P<0.05）；术后健侧和患侧冠状、矢状、轴向下颌角差异均无统计学意义（P>0.05）。术前与术后健侧和患侧冠状、矢状、轴向下颌角差值的绝对值差异有统计学意义（P<0.01）。Ⅰ类缺损术前健侧和患侧矢状下颌角、术后健侧和患侧轴向下颌角差异有统计学意义（P<0.05），其余各类缺损术前与术后健侧和患侧三维下颌角差异均无统计学意义（P>0.05）。Ⅰ类缺损术前与术后健侧和患侧矢状、冠状下颌角差值的绝对值差异无统计学意义（P>0.05），其余各类缺损术前与术后健侧和患侧三维下颌角差值的绝对值差异均有统计学意义（P<0.05）。结论: 计算机辅助游离腓骨下颌骨重建对于肿瘤造成的三维方向的颌骨畸形均有显著的改善，能有效恢复下颌骨解剖结构的精确对称，应用本研究的评估方法能精确地评估下颌骨重建术后效果，为术前的设计提供指导。.

UNASSIGNED: Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients\' situation, motivation, and treatment course were structurally assessed.
UNASSIGNED: All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed.
UNASSIGNED: In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis.
UNASSIGNED: Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient\'s persistent motivation for the procedure.