[Reconstruction of complex loss of maxillary substance using a vascularized fibular flap after arteriovenous fistulization with a saphenous loop]. / Reconstruction d'une perte de substance complexe du maxillaire par transfert de fibula vascularisé après réalisation d'une fistule artério-veineuse par boucle vasculaire saphène.

INTRODUCTION: When major loss of bone stock requires a vascularized transfer, the poor quality of the receiver vessels may require complementary lengthening of the vascular pedicle. This can be achieved with venous bypasses or by preparing the recipient site with a vascular loop. We have used this later approach successfully in a patent with major tissue loss involving the maxillary bone. CASE REPORT: A 39-year-old man presented total loss of the maxillary tissues due to a firearm wound. A free fibular flap was considered. Due to the limited length of the fibular pedicle, and the scar tissue in the area of the vascular anastomoses, reconstruction was performed in two phases: first preparation of the recipient site with a saphenous loop then fifteen days later transfer of the fibular flap. DISCUSSION: This technique is an alternative to venous bypass which increases the risk of postoperative thrombosis. The objectives of the vascular loop are to position the anastomoses in a healthy area and to achieve end-to-end anastomoses. This technique has been described basically for the treatment of post-traumatic tissue loss of the limbs, but can be applicable for the face, particularly after radiation.