Dharnappa Poojary, K M Sandeep, K P Shetty, Sameep Shetty, Premalatha Shetty, Joanna Baptist, Ritesh Singh
{"title":"Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report.","authors":"Dharnappa Poojary, K M Sandeep, K P Shetty, Sameep Shetty, Premalatha Shetty, Joanna Baptist, Ritesh Singh","doi":"10.1186/s13256-025-05150-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Free fibula reconstruction of the mandible has been the gold standard for reconstruction of mandible owing to its rich periosteal and peroneal blood vessel supply. This demands a multidisciplinary approach of maxillofacial and plastic surgeons. Meticulous presurgical planning of harvesting fibula, resection of diseased bone, contouring the fibula to the created defect to restore the anatomy and function, microvascular anastomosis, and postoperative medical care are vital for the survival of the flap.</p><p><strong>Case series: </strong>We report a series of cases in four Indian patients. Case 1 involves a 23-year-old male individual, Case 2 involves a 47-year-old male individual, Case 3 involves a 23-year-old male individual, and Case 4 involves a 56-year-old female individual. All patients underwent fibula reconstruction of the mandible post-odontogenic and malignant tumor resections with incidental intraoperative mishaps and management with successful outcomes with a follow-up of 12 months.</p><p><strong>Results: </strong>All the above cases were done with a multidisciplinary approach, including plastic and maxillofacial surgeons. Despite the incidental mishaps, it was a learning experience for the betterment of the planning of future cases.</p><p><strong>Conclusion: </strong>Although the free fibula flap is a conventional method for reconstruction, there is a risk of error hidden in each of its subtle steps that can contribute to flap failure. Therefore, meticulous surgical planning is mandatory for execution of the treatment plan. Although complications are inevitable, they should not overshadow the learning opportunities from each respective case.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"109"},"PeriodicalIF":0.9000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895340/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s13256-025-05150-0","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Free fibula reconstruction of the mandible has been the gold standard for reconstruction of mandible owing to its rich periosteal and peroneal blood vessel supply. This demands a multidisciplinary approach of maxillofacial and plastic surgeons. Meticulous presurgical planning of harvesting fibula, resection of diseased bone, contouring the fibula to the created defect to restore the anatomy and function, microvascular anastomosis, and postoperative medical care are vital for the survival of the flap.
Case series: We report a series of cases in four Indian patients. Case 1 involves a 23-year-old male individual, Case 2 involves a 47-year-old male individual, Case 3 involves a 23-year-old male individual, and Case 4 involves a 56-year-old female individual. All patients underwent fibula reconstruction of the mandible post-odontogenic and malignant tumor resections with incidental intraoperative mishaps and management with successful outcomes with a follow-up of 12 months.
Results: All the above cases were done with a multidisciplinary approach, including plastic and maxillofacial surgeons. Despite the incidental mishaps, it was a learning experience for the betterment of the planning of future cases.
Conclusion: Although the free fibula flap is a conventional method for reconstruction, there is a risk of error hidden in each of its subtle steps that can contribute to flap failure. Therefore, meticulous surgical planning is mandatory for execution of the treatment plan. Although complications are inevitable, they should not overshadow the learning opportunities from each respective case.
期刊介绍:
JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect