title: Orbitomaxillary reconstruction using the layered fibula osteocutaneous flap.
abstract: OBJECTIVE
  To describe a surgical technique for total palatomaxillary and orbital reconstruction using a fibula osteocutaneous free flap in a layered fashion.
  
  
  METHODS
  Case series from a tertiary care facial plastic and reconstructive surgical practice including patients with postextirpative Brown 3a and 3b orbitopalatomaxillary defects undergoing immediate microvascular reconstruction. Application of the layered fibula free flap to composite maxillary defects permits single-stage, optimal reconstruction of contiguous orbitomaxillary defects, reconstitution of midface 3-dimensional contour, and restoration of the anterior alveolar arch with robust bone, thereby providing for potential sequential dental rehabilitation with osseointegrated implants.
  
  
  RESULTS
  This technique demonstrates excellent long-term symmetry, support, function, and aesthetic contour. Although patients may need minor, adjunctive procedures, this technique is flexible in design and offers reliable outcomes with a minimum of morbidity.
  
  
  CONCLUSIONS
  The fibula osteocutaneous free flap, because of its design flexibility and ability to provide structural support, is an excellent reconstructive option for total maxillary defects, including those that involve the orbit.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Taha Z
authors.initials: TZ
authors.lastname: Shipchandler
authors.forename: Heather H
authors.initials: HH
authors.lastname: Waters
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Knott
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D004954:Esthetics; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009915:Orbit / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016038:Skin Transplantation / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult