When oral, head and neck pathology patients need to reestablish their function and appearance, they can turn to oral and maxillofacial surgeons (OMSs) who have completed advanced training in the areas of reconstruction and microvascular surgery.
One of the procedures performed by OMSs to help patients who have had an oral pathology (e.g., cyst, tumor) and require bone reconstruction is free flap reconstructive surgery. The surgery – performed when patients need their jaw or parts of their face reconstructed – involves bone and soft tissue from different parts of the body. While this donor tissue can come from multiple locations in a patient’s body, mandibular (lower jaw) reconstruction is most commonly performed through a fibula free flap procedure. The fibula flap takes bone (and sometimes the skin and muscle) and its corresponding blood vessels from a patient’s lower leg and uses it to rebuild the structures of the face/jaws.
What Does Free Flap Surgery Involve?
The procedure often takes 9 to 12 hours. During surgery, the OMS will:
- Remove the cancer/tumor/pathology from the jaw and soft tissue surrounding it.
- Remove bone/skin/muscle as needed along with a connected vein and artery from the patient’s body.
- Shape the bone from the donor site to match the removed portion of the jaw.
- Connect the artery and vein from the donor to the head and neck.
- Secure the new jawbone with plates and screws, and cover the area with soft tissue.
- Suture the face and neck to connect the soft tissue.
Advantages of the Fibula Free Flap
There are unique advantages to using the fibula for reconstructive surgery, including:
- Up to 10 inches of bone length available.
- Excellent height and contour for the reconstruction of the jawbone.
- Ease of obtaining from the donor site with few side effects for the patient.
- Bone that can be contoured to match the jaw.
- Dental implants can be placed into this bone.
While the patient's leg will be bandaged following surgery, the removal of the fibula usually has minimal impact on walking. Many patients are able to resume light walking within a week and climbing stairs within two weeks. It can be necessary to remove skin in addition to the fibula – if the surgeons do remove skin from the leg, it may be replaced with a skin graft.
Learn More about Treatment for Oral, Head and Neck Pathologies
People experiencing symptoms of oral, head and neck cancer, including difficulty swallowing or abnormal lumps around the neck or jaw, should contact an OMS for a consultation. After a diagnosis, the fibula free flap and other options may be discussed.