Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications.

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The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside) oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.





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Kokosis, George, Robin Schmitz, David B Powers and Detlev Erdmann (2016). Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications. Archives of plastic surgery, 43(1). pp. 3–9. 10.5999/aps.2016.43.1.3 Retrieved from

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David Bryan Powers

Professor of Surgery

Dr. Powers currently serves as a Professor of Surgery, and Director of the Craniomaxillofacial Trauma Program, at Duke University Medical Center.  Additionally, he is the Fellowship Director for the Craniomaxillofacial Trauma and Reconstructive Surgery fellowship within the Department of Surgery. His surgical experience in facial trauma was attained during a military career highlighted by the acute management of ballistic and other injuries of warfare, as well as performing secondary and tertiary facial reconstructive surgery during various staff assignments at Wilford Hall USAF Medical Center, the Walter Reed National Military Medical Center – Bethesda and the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.  He lectures and has published extensively on the management of ballistic and high-energy transfer injuries to the craniomaxillofacial skeleton, comprehensive reconstruction techniques for facial trauma, and the use of computer-aided surgical planning and patient-specific implants for anatomic rehabilitation after catastrophic craniomaxillofacial injuries.


Detlev Erdmann

Professor of Surgery

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