title: The medial approach to the fibula: a feasible alternative.
abstract: OBJECTIVE
  Since the first harvesting of a microsurgical fibula in 1974 by Ueba and in 1975 by Taylor, using the fibula for osseous reconstruction has proven to be a valuable approach. The harvesting technique, which has been refined by subsequent investigators, has become increasingly standardized, today providing a clear, reproducible method. The procedure involves elevating the fibular graft from lateral, choosing the shortest route to reach the fibula. One disadvantage of this approach is that the bone often obstructs visualization of the vascular pedicle, which lies medially, promoting unintentional injury. In addition, this method is associated with some donor site morbidity, prompting further investigations into accessing the fibula. Here we present an alternative approach for harvesting the fibula and highlight the pros and cons of each approach.
  
  
  METHODS
  Between 1999 and 2006, a total of 38 microsurgical (23 for the mandible, 9 for the extremities, and 6 for the maxilla) fibula grafts were harvested through the medial approach.
  
  
  RESULTS
  In all cases, the patency of the posterior tibial, peroneal vessels, and the tibial nerve could be visualized. Two flaps failed (both mandible, for a success rate of 94.7%). No ischemic or wound healing complications of the lower limb were observed.
  
  
  CONCLUSIONS
  The medial approach for harvesting the fibula is a feasible alternative to the lateral approach and provides the surgeon with a comparable likelihood of success. If for some reason access from the lateral approach is contraindicated, then the medial route should be considered.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. blake@uke.uni-hamburg.de
authors.forename: Felix
authors.initials: F
authors.lastname: Blake
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzle
authors.forename: Juergen
authors.initials: J
authors.lastname: Harms
authors.forename: Heiner
authors.initials: H
authors.lastname: Werle
authors.forename: Philipp
authors.initials: P
authors.lastname: Pohlenz
authors.forename: Lei
authors.initials: L
authors.lastname: Li
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D005121:Extremities / Q000601:surgery; D005240:Feasibility Studies; D005360:Fibula / Q000098:blood supply / Q000294:innervation / Q000637:transplantation*; D006801:Humans; D007511:Ischemia / Q000150:complications; D008866:Microsurgery / Q000379:methods; D056948:Orthognathic Surgical Procedures; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation; D013977:Tibia / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome