title: Is distal fibular fracture an absolute contraindication to free fibular flap harvesting? A review of evidence in the literature and illustration by a successful case.
abstract: Despite the advantages of a fibula flap, many surgeons would often be hesitant in its use in patients with a history of distal fibular fracture. The chief concern is the potential vascular damage sustained during the injury. From our experience, however, we noticed that the blood supply of various components of a fibula flap rarely relies on its distal part alone. Avoiding the use of this flap may unnecessarily forgo the optimal reconstructive option in many patients. Free fibula flap was harvested from a 41-year-old man who had a history of left fibula fracture 10 years before surgery. The fracture was treated with open reduction with internal fixation. The plate was removed 1 year after the trauma surgery. We used this fractured and healed fibula to reconstruct the intraoral and mandibular defect after tumor extirpation. The harvesting process was straight-forward and the flap survived uneventfully. On the basis of our experience and current evidence in the literature, we believe that a history of previous fibular fracture should not be considered as an absolute contraindication for free fibular flap harvesting. With a good knowledge of the lower limb anatomy and appropriate patient selection, the fibular flap can still be a safe option that incurs no additional risk.
authors.affiliation: Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong.
authors.forename: Richie Chiu-Lung
authors.initials: RC
authors.lastname: Chan
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
authors.forename: Jason Kin Fai
authors.initials: JK
authors.lastname: Wong
authors.forename: Chao-Min
authors.initials: CM
authors.lastname: Wu
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D000075202:Contraindications; D005360:Fibula / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply; D020858:Tissue and Organ Harvesting