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The aim of the present study was to determine the morphometric characteristics of the fibular notch (FN). This study was carried out with 76 dry adult tibial bone specimens (right 38, left 38) with unknown age and sex collected from the Department of Anatomy, Cukurova University, Adana. The mean width of the FN was 23.04 ± 2.02 mm; the mean depth of the FN 3.63 ± 0.83 mm; the mean height of the FN was 41.76 ± 4.01 mm. The mean anterior facet length and posterior facet length was found to be 10.44 ± 1.94 mm and 13.93 ±1.63 mm, respectively. The mean value of the angle between the anterior and posterior facets was found to be 140.56° ± 11.72. The mean value of the angle between the anterior surface of the tibia and the intertubercular line was 75.5° ± 5.47. No statistically significant differences were detected between the right and left sides for all measurements. It is considered that knowing the morphometric and anatomical characteristics of the fibular notch in detail will help radiologists evaluate the talocrural region. It is also considered that these data will guide surgeons and help determine the appropriate size for ankle reconstruction operations.

BACKGROUND: Segmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, and contraindications to consider during their selection.
OBJECTIVE: To compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF).
METHODS: We conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients\' prognosis were evaluated. Patients\' satisfaction and Derriford Appearance Scale (DAS59) were assessed during follow-up.
RESULTS: Ameloblastoma was the most frequent diagnosis (52.9% managed by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% managed by IOA vs 88.2% by EOA). Compared with EOA group, IOA group had less intraoperative blood loss (mean difference [MD] = -112.2, 95% confidence interval [CI]: -178.9 to -45.5, p = 0.001), higher satisfaction score (MD = 1.3, 95% CI: 0.9 to 1.7, p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI: -0.7 to -0.2, p ˂ 0.001).
CONCLUSIONS: Both IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. Patients managed with IOA were more satisfied with aesthetic outcomes than patients managed with EOA. In the absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site, patients should always be referred to an implantologist and/or prosthodontist for teeth restoration to improve functional and aesthetic outcomes.

Objective:To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. Methods:Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant（P>0.05）, which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm², and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm², and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups. Results:The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups （P>0.05）. According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction（P>0.05）, and at 12 months after surgery（P<0.05）. Conclusion:The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.
目的：探讨游离腓动脉分叶穿支皮瓣修复口腔癌术后复合性缺损的临床效果。 方法：选取2018年1月—2022年1月蚌埠医科大学第一附属医院口腔颌面外科收治的口腔癌患者48例，其中颊癌8例、口底癌7例、舌癌14例、磨牙后区癌5例，上颌牙龈癌9例，下颌牙龈癌5例。病灶切除术后，实验组24例采用腓动脉分叶穿支皮瓣修复缺损，对照组24例采用腓动脉单叶穿支皮瓣修复缺损。术中实验组皮瓣切取范围为38.5～74.5 cm²，供区减张缝合；对照组皮瓣切取范围为61.0～76.5 cm²，供区植皮缝合。记录并比较2组皮瓣成活以及患者存活情况。术后6个月及12个月分别对患者进行门诊随访，利用洼田饮水试验、功能性经口摄食量表和汉语语言清晰度测试字表分别对患者吞咽功能、语音功能进行评价，并记录患者对修复外形的主观满意度。2组患者均获随访，随访12～60个月，利用Kaplan-Meier法计算患者累积生存率，绘制生存曲线，采用log-rank检验进行组间生存曲线比较。 结果：2组皮瓣成活率均为100%。术后5年实验组患者生存率为62.5%，对照组为54.2%，2组差异无统计学意义（P>0.05）。2组患者术后6个月的吞咽功能、语音功能及主观满意度比较差异均无统计学意义（P>0.05）；术后12个月，2组差异均有统计学意义（P<0.05）。 结论：游离腓动脉分叶穿支皮瓣可分别修复口腔癌术后复合缺损的不同解剖结构，可有效提高术后功能恢复程度和患者满意度。腓动脉分叶穿支皮瓣是重建口腔癌术后复合缺损的理想皮瓣。.

OBJECTIVE: To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients.
METHODS: Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review.
RESULTS: Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p < .001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up.
CONCLUSIONS: Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%.
CONCLUSIONS: FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up.
BACKGROUND: Clinical trial registration is not applicable as this study comprehends a retrospective analysis.

BACKGROUND: A comprehensive understanding of the anatomy of the anterolateral ankle joint and its interrelationships is essential for advancing the development of minimally invasive Broström-Gould procedure, thereby enhancing surgical efficacy and minimizing postoperative complications.
METHODS: Ten fresh human ankle specimens were dissected to observe the shape and trajectory of the lateral bundle of the inferior extensor retinaculum (IER) and its relationship with the deep fascia. To observe the relationship between the ankle capsule and the anterior talofibular ligament (ATFL). The center of the insertion point of ATFL at the lateral malleolus was used as the reference point. The vertical distance from the reference point to the fibula tip, the horizontal distance from the reference point to the lateral branch of the superficial peroneal nerve, the shortest distance from the reference point to IER, the narrowest width of the IER, the angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula were measured. The tension and elasticity of ATFL was understood. To describe the minimally invasive Broström-Gould procedure according to the anatomical characteristics of the anterolateral ankle joint.
RESULTS: Among the 10 cases, 8 cases (80%) had double bundles of ATFL, 2 cases (20%) had single bundle of ATFL, and no outer superior oblique bundle was observed in IER. The vertical distance from the reference point to the fibula tip was 1.2 ± 0.3 (range 1.1-1.3) mm. The shortest distance from the reference point to the level of the superficial peroneal branch was 28.2 ± 4.3 (range 24.5-32.4) mm. The shortest distance from the reference point to IER was 12.5 ± 0.6 (range 12.1-12.9) mm, and the width of IER at this point was 7.2 ± 0.3 (range 7.0-7.6) mm. The angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula was about 60° ± 2.8° (range 58.1°-62.1°) mm. The space between the anterolateral deep fascia of the ankle joint and the ankle capsule is very small, and only a few fat granules are separated between them. The ATFL is largely fused to the ankle capsule. The ATFL exhibited high tension and poor elasticity after traction with the probe hook.
CONCLUSIONS: The results showed that in the minimally invasive Broström-Gould technique for lateral ankle stabilization, the Broström procedure actually sutured the insertion of the ATFL together with the ankle capsule to the anterior edge of the lateral malleolus. In the Gould procedure, the deep fascia was mostly reinforced with the ankle capsule. The minimum suture span was obtained when the Gould suture needle direction was at an Angle of 60° to the longitudinal axis of the fibula.

Isolated fractures of the distal fibula mainly affect young, active people. In most cases, fixation is by open reduction with or without casting for six weeks without weight bearing. The current trend is to reduce this period of non-weight-bearing in order to promote earlier functional rehabilitation. The improved mechanical stability resulting from the use of plates with locking screws has changed the postoperative management of many fractures, but there is little evidence for the ankle. Between October 2013 and August 2015, 36 patients were enrolled in a prospective study to evaluate the performance of internal fixation of isolated distal fibular fractures using a lateral anatomically contoured titanium locking plate (InitialA® plate from Newclip Technics, Haute Goulaine, France) with immediate mobilisation and full weight bearing. No patient required further surgery due to mechanical failure or non-union. The bone healing rate was 100 % at 3 months. Two patients had septic complications requiring plate removal and antibiotic treatment and were eventually cured. The use of anatomically contoured locking plates provides strong and stable fixation, allowing immediate full weight-bearing. Such a technique has the advantage of a short recovery time and an early return to work without additional complications.

OBJECTIVE: Gap non-union of long bones are challenging problems in orthopaedic patients. Non-vascularized fibular grafting is a simple, cost effective, single stage procedure and is an accepted method of reconstruction for gap non unions in children. However, there is a risk of non-union when a long avascular strut of fibula is used. The periosteum, by itself has high biological activity and is helpful in osteointegration. Harvesting the fibula with the periosteum gives the advantage of mechanical and biological support in a gap non-union.
METHODS: During 2020 to 2022, 13 patients presented to us with gap nonunion of long bones due to various aetiology. The mean age of the patients was six years with a mean bone gap of 4.2 cm. A modified technique of harvesting the fibula with the periosteum is described. The graft was stabilized with the recipient bone by intra medullary or extra medullary implants.
RESULTS: Union occurred in average 12.7 weeks in all except one patient with congenital pseudoarthrosis of tibia. The fibula on the harvest site regenerated completely in all other patients. One patient had a superficial infection. Children were followed were an average of 17.5 months and there was no incidence of graft resorption or fracture. Osteoperiosteal fibula graft is a simple, effective and cost-effective procedure for the treatment of gap non-unions in children. It offers the advantage of both biological and mechanical support, with high union rates and low complication rates.

Background: The aim of this study was to evaluate the difference between pre- and post-operative radiotherapy on the progress of ossification after free fibula flap reconstruction of the mandible using three-dimensional (3D) analysis. Methods: A total of 38 free fibula reconstructions of the mandible were evaluated retrospectively for ossification between bone segments by measuring Hounsfield Units (HU) in at least two postoperative computer tomography scans (average of 2.4 scans per patient; around the 5th, 12th, 16th, and 19th month postoperative). Three subgroups were created according to the time of irradiation: preoperative radiotherapy (preORT) (n = 11), postoperative radiotherapy (postORT) (n = 16), and patients without any radiation therapy (n = 11) as the control group (noRT). HU in eight regions of interest (ROI) and overlapping surfaces between segments per contact point, as well as influencing factors, were analyzed. Results: The fastest progress in gain of HU ossification with a difference of 0.30 HU/day was observed in noRT compared to preORT (p = 0.002). postORT was -0.24 HU/day slower than preORT (p = 0.005). Original and grafted bone showed a significantly slower HU uptake than between two graft segments with -84.18 HU/day (p < 0.001). Moreover, a larger initial overlapping surface between the segments in cm2 resulted in a higher rise of HU/day (p < 0.001). Conclusions: 3D analysis of post-reconstructive CT scans shows prolonged ossification of mandible reconstructions by free fibula after head and neck radiation. The effect is distinct in cases with post-operative adjuvant radiotherapy. The effects of radiotherapy on ossification may be minimized by a larger initial contact surface and improved operational techniques. Moreover, HU longitudinal measurements and 3D analysis offer new perspectives for clinical evaluation of successful bony healing.

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