Free Fibular Transfer for Facial Reconstruction in the Pediatric Patient

Background: The use of osteocutaneous fibular free flaps in adults has been well described in the literature, but the data on their use in the pediatric population is lacking. Free fibular transfer allows for reconstruction of skeletal defects greater than 6cm and offers a skin paddle for intraoral coverage. The fibula dissection can be accomplished with relative ease and with little donor site morbidity making it an ideal option for pediatric patients [1].

Materials & Methods: This retrospective study reviewed patients treated at either Bellevue Hospital Center or NYU Langone Medical Center by the Department of Oral & Maxillofacial Surgery from 2006 to 2013. Patients were included in the study if they were age 21 or younger and had undergone reconstruction with free fibular transfer.

Method of Data Analysis: 12 participants were found to fit the inclusion criteria and were followed for an average of 16 months (range 1-42 months).

Results: The mean age was 16.5 years (range, 10-21 years) including both males (n=7) and females (n=5).  Indications included Ameloblastoma (n=6), Hemifacial microsomia (n=3), Ectodermal dysplasia (n=1), Osteoradionecrosis (n=1) and Arteriovenous malformation (n=1).  Locations included the mandible (n=9), maxilla (n=2), and orbit (n=1) with immediate endosseous implant placement in 9 of 12 cases. Two patients had infectious complications, one requiring removal of hardware and one requiring removal of non-vital bone with an overall success rate of 92%.

Conclusions: In adults, immediate reconstruction with free fibular transfer, most commonly due to malignancy, has improved post-operative rehabilitation and functional status. At our institution, this procedure has been tolerated well in the pediatric population with success rates consistent with those previously reported [2]. Though our follow up time is somewhat limited, both donor and recipient site morbidity have been low. In our experience, children appear to be ideal candidates for free fibular transfer due to their lack of underlying systemic illness, pristine anatomy and uncomplicated healing. Future study at our institution includes growth analysis of native bone versus implanted fibula construct.

References

1. Upton, J; Guo, L, et al. Pediatric free-tissue transfer. Plastic and Reconstructive Surgery. 2009: Vol 124. Num 6: 313-326e.

2. Arnold, D; Wax, M, et al. Pediatric microvascular reconstruction: a report from the microvascular committee. Otolaryngology-Head and Neck Surgery. 2007: 136. 848-851