Unicortical Bone Necrosis of the Fibula Free Flap Associated to the Fixation with a Nonlocking 2.0-mm Reconstruction Plate and Screws

Abstract

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

Keywords

bone plates - osteonecrosis - free tissue flaps - reconstructive surgical procedures - postoperative complications

Author Contributions

G.N.P.: Responsible for planning, collecting and interpreting data, writing the manuscript, review of the final version, and answering to the reviewers. D.R.: Responsible for collecting and interpreting data and review of the final version. L.S.: Responsible for collecting and interpreting data and review of the final version. H.F.: Responsible for critical review, important intellectual content, and approval of the final version. A.R.S.: Responsible for critical review and important intellectual content.

Patient Consent

Informed consent was obtained from all individual participants included in the study.

Publication History

Article published online:
27 May 2022

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