Vascularised fibula osteocutaneous flap for cervical spinal and posterior pharyngeal wall reconstruction

ABSTRACT

We report a case of vascularised fibula osteocutaneous flap used for composite cervical spinal and posterior pharyngeal wall reconstruction, in a patient with recurrent skull base chordoma, resected by an anterior approach via median labio-mandibular glossotomy approach. Bone stability and pharyngeal wall integrity were simultaneously restored

KEY WORDS

Free fibula flap - head and neck reconstruction - cervical spinal reconstruction - skull base chordoma - mandibulotomy approach

• REFERENCES

• 1 Lanzino G, Dumont AS, Lopes MB, Laws ER Jr. Skull base chordomas: Overview of disease, management options, and outcome. Neurosurg Focus 2001;10:E12.
• 2 Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 2006;59:ONS50-7
• 3 Hassan S, Abdullah JM, Wan Din SJ, Idris Z. Combined use of maxillomandibular swing approach and neurosurgical ultrasonic aspirator in the management of extensive clival chordoma: a case report. J Med Case Reports 2008;2:49
• 4 Bernard TN Jr, Whitecloud TS 3rd. Cervical spondylotic myelopathy and myeloradiculopathy: Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop Relat Res 1987;221:149-60.
• 5 Macdonald RL, Fehlings MG, Tator CH, Lozano A, Fleming JR, Gentili F, et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 1997;86:990-7.
• 6 Gross TP, Jinnah RH, Clarke HJ, Cox QG. The biology of bone grafting. Orthopedics 1991;14:563-8.
• 7 Burchardt H. Biology of bone transplantation. Orthop Clin North Am 1987;18:187-96.
• 8 Rossier AB, Hussey RW, Kenzora JE. Anterior fibular interbody fusion in the treatment of cervical spinal cord injuries. Surg Neurol 1977;7:55-60.
• 9 Bradford DS. Anterior vascular pedicle bone grafting for the treatment of kyphosis. Spine (Phila Pa 1976) 1980;5:318-23.
• 10 Rose GK, Owen R, Sanderson JM. Transposition of rib with blood supply for the stabilisation of a spinal kyphos. J Bone Joint Surg (Br) 1975; 57:112.
• 11 Wittenberg RH, Moeller J, Shea M, White AA 3rd, Hayes WC. Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion. Spine (Phila Pa 1976) 1990;15:1073-8.
• 12 Smith MD, Cody DD. Load-bearing capacity of corticocancellous bone grafts in the spine. J Bone Joint Surg Am 1993;75:1206-13.
• 13 Wright NM, Kaufman BA, Haughey BH, Lauryssen C. Complex cervical spine neoplastic disease: Reconstruction after surgery by using a vascularised fibular strut graft. J Neurosurg 1999;90: 133-7.
• 14 Freidberg SR, Gumley GJ, Pfeifer BA, Hybels RL. Vascularised fibular graft to replace resected cervical vertebral bodies. Case report. J Neurosurg 1989;71:283-6.
• 15 Nemoto K, Asazuma T, Amako M, Kawaguchi M, Yamagishi M, Mizuno H. Vascularised fibula graft for spinal fusion in severe cervical kyphosis due to neurofibromatosis. J Reconstr Microsurg 1997;13:559-62.
• 16 Erdmann D, Meade RA, Lins RE, McCann RL, Richardson WJ, Levin LS. Use of the microvascular free fibula transfer as a salvage reconstruction for failed anterior spine surgery due to chronic osteomyelitis. Plast Reconstr Surg 2006;117:2438-45
• 17 Ng RL, Beahm E, Clayman GL, Hassenbusch SJ, Miller MJ. Simultaneous reconstruction of the posterior pharyngeal wall and cervical spine with a free vascularised fibula osteocutaneous flap. Plast Reconstr Surg 2002;109:1361-5.
• 18 Winters HA, van Engeland AE, Jiya TU, van Royen BJ. The use of free vascularised bone grafts in spinal reconstruction. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2008.11.037
• 19 Krishnan KG, Müller A. Ventral cervical fusion at multiple levels using free vascularised double-islanded fibula - a technical report and review of the relevant literature. Eur Spine J 2002;11:176-82.