Colleen: If you were my spouse, I'd say "Go for it"...my hubby was 76 y/o when he had removal/replacement following bilateral neck dissection....read forum posts for details...His surgery was July 19, 6 short months ago..followed by radiation & chemo....You're young!

Lois

Hey Colleen,
My leg issues come from the donor leg being slightly weaker than my other leg. Make sense since they have taken some of it's support bone away. I CAN run if I want to, but would rather not as it puts alot of pressure on that leg. I also find that I can't raise it up as high as the "good" leg if I don't concentrate. I have a new dog and put up some gates to keep her confined to the family room until I have her housebroken. The first time I stepped over the gate I took quite a tumble. I led with my good leg and my donor leg didn't raise up high enough to clear the gate........and over I went. Now I lead with my donor leg and dont have any issues.

My donor site on my thigh from my last surgery is about 50% healed. It's been a real pain in the you know what! But, it's not as painful and I have dressings now to wear so I can come and go as I please.
Take care,
Minnie

Minnie, Lois, and anyone else with experience with this surgery,

Like Colleen, I am considering reconstruction with a fibular flap and have a few questions to add.
If this was done at a different time than other treatment or surgery, how long was the hospital stay?
One of my concerns is that I live in a 2 story home. Did you or your patient have any restrictions on going up and down stairs?
Was PT required?
Did you need a walker?
For each of these questions for how long was this an issue?
Have you experienced any problems with standing for a long time?
Was any dental replacement performed such as implants? My dentist has recommended that I have reconstruction because my bite is shifting.

Has any one had negative experiences following this surgery.

Thanks, it is because I am considering this surgery that I came to OCF.
Malka

Malka, my surgeon says that I would be in the hospital about a week. I think that is to be sure that the grafted artery stays open and that the graft isn't lost. EEK!

I, too, want to know about the process itself...how long I will need care of someone else...how long before I can speak normally...what the chances are of permanent leg problems.

I have met two ladies who have had this surgery--for maxillary and palatal loss. One, Gloria, is in Jasper, TX, and the other, Cheryl, is in Shrevcport. Both were very forthcoming. So at least I have a source of information.

I have even looked into Cheryl's mouth, and I have seen her pictures from start to finish.

My prosthodontist has been more informative than my surgeon. He says that some doctors are placing implants into the grafted bone at the time of surgery, he prefers to have about six months of healing time first. Then he places implants, which need about six months to ossify before they can accept any sort of load. In the meantime, there are various cosmetic denture devices that can be used for cosmetic purposes. The implants are not dental implants. They are implants to hold a removeable bridge.

I plan to call her soon with my list of questions. One difference in her tumor, while more extensive than mine, was not malignant. She did have a larger "defect" and couldn't get satisfaction with the obturator. That is not an issue for you, Malka, but you have other reasons to want this surgery.

Our surgeries would be different, but the issues with the harvest of the fibula would be the same.

I'll make contact with her soon, and I'll ask questions for both of us. She is doing great, evidently.

Malka...and others...I have learned that the first step in the process is to have an arteriogram to be certain that the artery is suitable for transfer, and that the circulation of the leg will be able to handle the artery's loss. Arteriograms are done in day-surgery, I think, since they involve inserting a catheter into the artery in the groin, and there is a danger of bleeding. I don't think that it matters which leg they take the bone from.

The surgery involves a long incision on the side of the calf, and the removal of the middle portion of the fibula, --not the entire length, and not the ends--along with tissue, skin, and the artery, all in a package. I don't know how the leg wound is closed.....whether it requires a graft from somewhere else, or whether it can be closed with something artificial or by granulation. It leaves a significant oval paddle-shaped scar, in addition to the long incision.

This "package" is installed into the mouth (your surgery will be different from mine) The bone is buttressed to the adjacent bone, in front and in the rear, and secured with wires and small plates and screws. the skin will cover the bone and any defect in the floor of your mouth, and attatch, I suppose, to ....the cheek. The artery is threaded down into the neck and inserted into an artery there, to provide circulation to the graft. If that artery closes off, the graft will die, and the procedure will be a failure.

They quoted me a 15% failure rate of some portion of the procedure....higher than normal for other surgeries....

My surgeon said I would be in the hospital for about a week. I don't know if there is some chance of breathing problems.....always a chance with serious oral surgery.....and then I'm sure they will want to watch for signs of failure of the graft .....or other problems.

The girl I know...Cheryl....returned to work at about 3 weeks, but she is in PR and she wouldn't return without teeth, and the prosthodontist didn't want to make her any sort of appliance any sooner. Her defect extended from the jaw around the front of her mouth, and included much of her palate. Mine is not that extensive. He said that he could make me something sooner than that. I have all of my own front teeth....the four incisors, and then the rest of them, and the bone, are gone on the right side. I could manage for a couple of weeks to stay close to home and send someone else to the grocery store.

I will ask Cheryl how much help she needed during that time. The leg would be the primary limiting factor during that time.

More later.....--Colleen

Hi Everyone,
When I had my free flap I was in the hospital for 11 days, but I also had a neck dissection at the same time. I had a trach and once the trach was removed (three days I believe it was) I was talking normally, exactly as I did before the surgery. It didn't affect my speech. The incision on my leg was closed with simple staples, no graft needed whatsoever. Unless you look closely, you can barely see the scar on my leg today. I don't have any paddle shaped scar, I don't know where that came from. My chin and underneath of it was quite swollen for approx 5-6 weeks but I had no pain from it. Once the swelling started going down, it went down quickly. My jaw is not proportioned with the rest of my face and people find it hard to believe that half of my jaw was removed.
My leg isn't as strong as my other leg in terms of jumping and running. But in everyday functions, I don't even think about it. I can stand up all day if needed, althogh there will be a slight burning sensation in my donor leg after hours of standing. Please believe me when I tell you that the leg is not an issue to worry on. When I came home, I had a walker but mine was more because they had put the cast on my leg to tight and when it was removed, we discovered a huge decubitus ulcer on my heel and on the top of my foot. That caused me many problems as I couldn't put my heel on the ground to walk. Even with that unusual side effect, I was walking on my own with a walking boot within two weeks, up and down stairs and anywhere else I needed to go.
I was also eating two days after leaving the hospital, eating normally and anything I wanted. mind you this was before I had radiation.

Hope all of this helps. The surgery is worth the advantages you will get from the few weeks of discomfort.

Love,
Minnie

Another question for those who have gone through this,

From what I have learned it seems that the surgical part will be covered but it my understanding that the dental implants are not. Has anyone had any sucess with having at least a portion of the dental paid by either a regular insurance or a Medicare supplemental plan?
I do not want to have the surgery until this summer. By then I will be on a Medicare supplemental plan. I have a son in Iraq who will not be home until some time in April. Also I want to do some very serious spring cleaning into every corner of the house. I normally do this every year before Passover but year before last we were still in the trailer and last year I only did minimal cleaning except in the kitchen. I closed off a bedroom for storage, taped up bathroom cabinets and since many of our books which I would normaly shake out and dust were still in boxes I covered the others in bookcases. Pictures and art work which would have been dusted and the glass cleaned were not yet hung. I even shocked my family by using disposables for part of the Seder meals. This year I want to do an old fashioned ceiling to floor, corner to corner, matress turning, rug beating, dust flying,porch scrubbing type of cleaning. (I realy believe obsessive spring cleaning is a hormonal thing with females, particularly those of us in the South. It's just that since we have become liberated we have surpressed the urge.)

Malka, I can't believe that we are EXACTLY the same age....so I have Medicare questions also. I will ask my friend about insurance coverage, though she is nowhere near Medicare age.

Minnie...the paddle-shaped scar was on my friend who had a case like mine, with a maxillary repair needed, along with a palatal reconstruction. Perhaps there is some difference in the need for skin and tissue in that case.

I don't know how much new tissue is needed for reconstruction of the mandibular defect. Perhaps existing oral tissue is sufficient to cover the implanted bone.

I soso much appreciate everybody's input. I also received a helpful email from "Dragan"...Wayne. His past posts can be accessed through the Search feature here.

So far, nobody here has had a maxillary reconstruction, but still your responses are quite helpful to me, since the process is much the same.

XO

August,
Did you get my PM. I may somehow have sent it to myself.
My reconstruction failed, so you need to hear from me too.
Debbie

Debbie, I sure do need to hear from you, but no, I did not get a PM.....at least not that I know about. I don't navigate the new forum set-up as well as the old format. Thanks for writing. You are welcome to write me at my personal email, listed clearly at my "profile" page, or post here. Thanks.