Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report

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...

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Main Authors: Dharnappa Poojary, K. M. Sandeep, K. P. Shetty, Sameep Shetty, Premalatha Shetty, Joanna Baptist, Ritesh Singh
Format: Article
Language:English
Published: BMC 2025-03-01
Series:Journal of Medical Case Reports
Subjects:
Online Access:https://doi.org/10.1186/s13256-025-05150-0
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author Dharnappa Poojary
K. M. Sandeep
K. P. Shetty
Sameep Shetty
Premalatha Shetty
Joanna Baptist
Ritesh Singh
author_facet Dharnappa Poojary
K. M. Sandeep
K. P. Shetty
Sameep Shetty
Premalatha Shetty
Joanna Baptist
Ritesh Singh
author_sort Dharnappa Poojary
collection DOAJ
description 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.
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spelling doaj-art-624a9727e1bf42fb96e4e404cb120b592025-08-20T01:47:32ZengBMCJournal of Medical Case Reports1752-19472025-03-011911710.1186/s13256-025-05150-0Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case reportDharnappa Poojary0K. M. Sandeep1K. P. Shetty2Sameep Shetty3Premalatha Shetty4Joanna Baptist5Ritesh Singh6Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationDepartment of Plastic Surgery, Kasturba Medical College Mangalore, Manipal Academy of Higher EducationDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationDepartment of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher EducationAbstract 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.https://doi.org/10.1186/s13256-025-05150-0Free fibula flapReconstructionAmeloblastomaLingual platingQuality of life
spellingShingle Dharnappa Poojary
K. M. Sandeep
K. P. Shetty
Sameep Shetty
Premalatha Shetty
Joanna Baptist
Ritesh Singh
Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
Journal of Medical Case Reports
Free fibula flap
Reconstruction
Ameloblastoma
Lingual plating
Quality of life
title Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
title_full Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
title_fullStr Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
title_full_unstemmed Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
title_short Incidental mishaps and learning curves during free fibula reconstruction of mandible: a case report
title_sort incidental mishaps and learning curves during free fibula reconstruction of mandible a case report
topic Free fibula flap
Reconstruction
Ameloblastoma
Lingual plating
Quality of life
url https://doi.org/10.1186/s13256-025-05150-0
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