Flashcards on Head and Neck Reconstructive Surgery
Head and Neck Reconstructive Surgery: A Student Guide
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Fibula osteocutaneous flap mandibular reconstruction
65 cards
Card 1
Question: What recipient vessel is preferred for an ipsilateral fibula osteocutaneous flap in mandibular reconstruction to decrease vascular complications?
Answer: The ipsilateral superior thyroid artery (usually preserved by the surgical oncologist) is the preferred recipient vessel.
Card 2
Question: Why might the contralateral superior thyroid artery be an acceptable alternative recipient vessel for a fibula flap?
Answer: Because up to 10–15 cm of peroneal artery length can usually be harvested, allowing reach to the contralateral superior thyroid artery.
Card 3
Question: What fixation is recommended to bridge residual mandibular ends when using a fibula osteocutaneous flap?
Answer: A titanium reconstruction plate with at least two screws for each mandibular end.
Card 4
Question: What precaution should be taken when drilling and screw-fixing the fibula bone segments during plating?
Answer: Use unicortical drilling and screw fixation under irrigation to prevent overheating injury of the reconstructed bone.
Card 5
Question: Where can the reconstruction plate be positioned to achieve adequate height for future osseointegrated implants?
Answer: About 1 cm higher than the lower margin of the native mandible.
Card 6
Question: What technique can be used when a single fibula segment's height is insufficient for planned implants?
Answer: Perform a 'double-barrel' fibula flap to provide adequate and stable height for osseointegrated implants.
Card 7
Question: Name two modern technologies mentioned that assist complex mandibular reconstruction with fibula flaps.
Answer: Three-dimensional reconstruction images and rapid prototyping (3D printing) of physical models from computer-aided designs.
Card 8
Question: What is vertical distraction osteogenesis used for in fibula mandibular reconstruction?
Answer: To increase the reconstructed bone height.
Card 9
Question: How is ischemia time defined for the fibula flap in mandibular reconstruction?
Answer: From pedicle division through osteotomy, shaping and inset, ending with completion of the arterial anastomosis.
Card 10
Question: What ischemia time threshold is associated with a higher rate of partial flap loss for fibula osteocutaneous flaps?
Answer: Ischemia time greater than 5 hours is associated with statistically higher partial flap loss.