There are two long bones in the lower leg: the tibia (the main weight-bearing bone) and the fibula. The fibula can be safely transplanted with its blood supply to create a new jaw. The bone is usually good enough for dental implants once everything has healed and because of its blood supply it can be accurately shaped to replace the part of jaw required.

The surgical team have a great deal of experience of jaw reconstruction, successfully performing hundreds of jaw reconstructions between them. Alastair has conducted research in to the blood supply of fibular flaps and given lectures at big international meetings on the subject.

Procedure

Fibular flap surgery is usually performed at the same time as the cancer surgery to provide an immediate reconstruction. The procedure involves making a cut along the length of the outside of the lower leg.

Fibular flaps traditionally also include some skin to re-line the mouth. This means that the donor site then needs a skin graft to heal.

Luke and Alastair have developed techniques of reconstruction to eliminate the need for skin in the mouth. This has two major advantages: Firstly, the mouth then heals without skin which becoming more ‘mouth like’ and ready sooner for implants. Secondly, this helps the leg heal quicker by avoiding the need for skin grafts.

Patients understandably ask if they’ll manage without a fibular bone in the leg. The answer is that you can manage quite normally without it. The end parts of the bone contribute to knee and ankle stability and these parts are preserved.

Special scans are performed prior to surgery to assess the bone, as well as the blood supply and vessels in the leg, to ensure that it is safe to perform the surgery and that the vessels are of suitable quality.

Risks

Infection

Sometimes the leg wound can get infected, and if this happens usually this is managed sufficiently with a course of antibiotics.

Foot drop

Sometimes patients can find that their foot drags a bit whilst walking after surgery. This is because the common peroneal nerve is near to the top of the bone and can get bruised from surgery. In rare instances, this can be permanently injured.

Other symptoms reported include claw toe or contracture of the big toe. Physiotherapy is usually sufficient to help these symptoms. Patients are encourage to mobilise and walk with assistance from the first day post surgery.

Haematoma

Patients may develop haematomas or collections of blood in the wound after surgery. Drains are placed to prevent accumulation of fluid in the wound and these usually stay for a few days after the operation.

Delayed healing / loss of skin graft

The fibular free flap donor site is notoriously quite slow to heal and the graft often heals slowly.

Numbness

Some patients experience some numbness or altered sensation to the side of the lower leg, but this doesn’t seem to cause too much trouble for patients.