Treatment of severe atrophy of the maxilla with the prefabricated free vascularized fibula flap.

Treatment of severe maxillary atrophy despite complex major surgery often ends up with an unsatisfactory result. This paper presents the augmentation of the maxilla with a prefabricated free vascularized fibula flap in combination with ITI implants (Straumann AG, Waldenburg, Switzerland) in 4 patients. The technique of prefabrication for the reconstruction of maxillofacial defects is described based on the experience with 17 patients. The key points of this treatment are i) preoperative planning and fabrication of the drilling template; ii) prefabrication of the fibula with ITI implants and performing of a 'vestibuloplasty" using a skin graft; iii) technical construction and fabrication of the suprastructure and the denture; iv) reconstruction of the maxilla using the prefabricated fibula as free vascularized flap. The reconstructions with the fibula flaps were successful and the 18 ITI implants that have been inserted showed good osseointegration without loss of attachment in all 4 patients after a mean observation period of 12 months.