What is Fibular Free Flap Procedure
Fibular free flap procedure is surgery to remove part of the fibula to replace bone elsewhere in the body, such as the jaw. The fibula is one of the lower leg bones that runs from the knee to the ankle, parallel to the shin bone (tibia).
During this procedure, part of the fibula is removed along with some of the blood vessels and tissue around it. The fibula bone and tissue are then transplanted to another part of the body where bone and tissue were removed. This surgery is often used to treat people with head and neck cancer who have had part of the jaw removed.
Tell a health care provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any problems you or family members have had with anesthetic medicines.
- Any blood disorders you have.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
- Whether you smoke or use tobacco products. These can interfere with anesthesia and slow the healing process.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Infection.
- Bleeding.
- Allergic reactions to medicines.
- Damage to other structures or organs.
- Blood clots.
- Weakness in the area where the bone and tissue were removed.
What happens before the procedure?
Staying hydrated
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating and drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
Medicines
- Ask
your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider instructs you not to.
- You may be given antibiotic medicine to help prevent infection.
General instructions
- Plan to have someone take you home from the hospital.
- Ask your health care provider how your surgical site will be marked or identified. Your health care provider may identify multiple spots to remove bone and tissue.
- You may be asked to shower with a germ-killing soap.
- You may have a blood or urine sample taken.
- You may have imaging tests done, such as a CT scan or MRI.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash or sanitize their hands.
- Your skin will be washed with soap.
- Hair may be removed from the surgical area.
- An IV tube will be inserted into one of your veins.
- You
will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to numb the area (local anesthetic).
- A medicine to make you fall asleep (general anesthetic).
- A tube may be placed in your mouth, nose, or throat to help you breathe.
- If this procedure is being done to replace damaged or diseased bone and tissue (such as a tumor), the damaged or diseased area will be removed.
- A tourniquet will be placed on your thigh, and blood will be drained from the part of your leg where the bone and tissue will be removed.
- An incision will be made over your fibula.
- Muscle and tissue will be moved out of the way to allow access to the fibula.
- A thin, flexible metal saw will be used to remove a piece of bone from the fibula (donor site). The tissue and blood vessels (veins and arteries) around the bone will also be removed.
- The donor-site bone and tissue will be attached to the site where the damaged or diseased bone and tissue were removed (recipient site). The tissue and blood vessels from the donor site will be reattached to the tissue and blood vessels at the recipient site.
- The wound around the fibula will be closed. In some cases, skin from another part of the body may be needed to close the wound (skin graft).
The procedure may vary among health care providers and hospitals.
What happens after the procedure?
- Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
- You may have IV tubes inserted to provide medicines and nutrients while you are in the hospital.
- You will be given medicines to control pain. You may also be given antibiotics.
- You may be given a splint to wear on your leg.
- You may need to use a walker or crutches to help you walk.
- You may be instructed to do exercises to maintain the range of motion in your foot and leg.
- You may have to wear compression stockings. These stockings help prevent blood clots and reduce swelling in your legs.
- Ask your health care provider when it is safe to drive if you have a splint on your leg.
Summary
- A fibular free flap procedure is surgery to remove part of the fibula to replace bone elsewhere in the body, such as the jaw.
- During this procedure, part of the fibula is removed along with some of the blood vessels and tissue around the bone. The fibula bone and tissue are then transplanted to another part of the body where bone and tissue were removed.
- Follow instructions from your health care provider about eating and drinking before the procedure.
- You may be given a splint to wear on your leg after the procedure. You also may need to use a walker or crutches to help you walk.
Fibular Free Flap Procedure, Care After
This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.
What can I expect after the procedure?
After the procedure, it is common to have:
- Swelling, bruising, and pain in the lower leg where the bone and tissue were removed (donor site).
- Swelling, bruising, and pain at the site where the diseased tissue and bone were removed and replaced (recipient site).
- Grogginess from the medicines that you were given during the procedure.
Follow these instructions at home:
If you have a splint:
- Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
- Loosen the splint if your toes tingle, become numb, or turn cold and blue.
- Keep the splint clean.
- If the splint is not waterproof, do notlet it get wet. Cover it with a watertight covering when you take a bath or a shower.
Bathing
- Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when it is okay for you to shower.
- Keep the bandage (dressing) dry until your health care provider says it can be removed.
Incision care
- Follow
instructions from your health care provider about how to take care of your
incisions. Make sure you:
- Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
- Change your dressing as told by your health care provider.
- Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
Check your incision areas every day for signs of infection. Check for:
- More redness, swelling, or pain.
- More fluid or blood.
- Warmth.
- Pus or a bad smell.
Driving
- Do notdrive or use heavy machinery while taking prescription pain medicine.
- Ask your health care provider when it is safe to drive if you have a splint on your leg.
Activity
- Avoid activities that take a lot of effort (are strenuous) as told by your health care provider. Ask your health care provider what activities are safe for you.
- If physical therapy was prescribed, do exercises as told by your health care provider.
- Do notlift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
General instructions
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Use crutches or a walker as told by your health care provider.
- Keep your leg raised (elevated) above the level of your heart when you are sitting or lying down.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
- Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
- To
prevent or treat constipation while you are taking prescription pain
medicine, your health care provider may recommend that you:
- Drink enough fluid to keep your urine clear or pale yellow.
- Take over-the-counter or prescription medicines.
- Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
- Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have more redness, swelling, or pain around an incision.
- You have more fluid or blood coming from an incision.
- Your incision feels warm to the touch.
- You have pus or a bad smell coming from an incision.
- You have a fever.
- Your pain and mobility do not improve.
Get help right away if:
- You have severe pain that cannot be controlled with medicine.
- You have increased swelling, redness, or warmth in your arms or legs.
Summary
- After this procedure, it is common to have swelling, bruising, and pain in the lower leg where the bone and tissue were removed (donor site). You may also have these symptoms at the site where the diseased tissue and bone were removed and replaced (recipient site).
- Avoid strenuous activities as told by your health care provider. Ask your health care provider what activities are safe for you.
- Do not drive or use heavy machinery while taking prescription pain medicine.
- Use crutches or a walker as told by your health care provider. Keep your leg raised (elevated) when sitting or lying down.
- Follow instructions from your health care provider about how to take care of your incisions.
