title: A shift from the osteocutaneous fibula flap to the prelaminated osteomucosal fibula flap for maxillary reconstruction.
abstract: BACKGROUND
  Reconstruction of the maxilla with the fibula free flap is a popular and well-described technique. The ideal intraoral lining would be mucosa, which is moist, thin, and non-hair-bearing. Prelamination of the fibula with buccal mucosa replaces like tissue with like tissue, obviates the need for a skin paddle, and facilitates placement of osseointegrated implants in a single stage. For central maxillary defects, the authors have shifted from using an osteocutaneous to a prelaminated free fibula flap. In this article, the authors report their experience using the prelaminated osteomucosal fibula for maxillary reconstruction.
  
  
  METHODS
  From 2003 to 2011, 24 patients underwent reconstruction of a central maxillary defect using a free fibula flap. The first 10 patients had osteoseptocutaneous flaps, and the other 14 patients had prelaminated flaps. Data collected included patient age, cause of defect, type and number of operations, complications at both the donor and recipient sites, and placement of osseointegrated implants.
  
  
  RESULTS
  The majority of patients in the series (n = 21) had central maxillary defects caused by loss of the premaxilla during early repair of bilateral cleft lip-cleft palate. There was one flap failure in the nonprelaminated flap group and one in the prelaminated group. Repeated debulking to thin the skin paddle was required in all of the patients with osteocutaneous flaps.
  
  
  CONCLUSIONS
  Prelamination delivers like tissue to the recipient site, obviates the need for debulking, and may reduce donor-site wound problems. To the authors' knowledge, this is the largest series of prelaminated fibulas for maxillary reconstruction in the literature.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Mexico City, Mexico From the Department of Plastic and Reconstructive Surgery, Division of the Medical School, Universidad Nacional Autónoma de México, Hospital General Dr. Manuel Gea González.
authors.forename: Eric
authors.initials: E
authors.lastname: Santamaria
authors.forename: Susana
authors.initials: S
authors.lastname: Correa
authors.forename: Rachel
authors.initials: R
authors.lastname: Bluebond-Langner
authors.forename: Hector
authors.initials: H
authors.lastname: Orozco
authors.forename: Fernando
authors.initials: F
authors.lastname: Ortiz-Monasterio
mesh_terms: D000293:Adolescent; D000328:Adult; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D016142:Holoprosencephaly / Q000601:surgery; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D009061:Mouth Mucosa; D016348:Osseointegration; D019340:Osteotomy, Le Fort / Q000379:methods*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult