Free Fibula Flaps Under Loupe Magnification; A Viable Option For Reconstruction Of Bony Defects In A Resource Constrained Environment

Abstract

Reconstruction of bony defects either posttraumatic or secondary to tumour surgery can be challenging and demanding. Extensive bony defects are best managed by free flaps. In many centers in the developed world this is done by the aid of microscopes. However in many developing countries especially in sub-Saharan Africa Microscopes are not readily available. In this presentation we present ,our experience with the use of loupes in doing free fibula flaps at Kenyatta National Hospital; a tertiary public hospital in Kenya. A total of fifteen patients with extensive bony defects requiring reconstruction were followed in this study .Thirteen patients needed reconstruction of the mandible with one patient the radius and one the tibia. The overall flap success rate was about ninety percent. In conclusion, even in centers where microscopes are not readily available, successful reconstruction of extensive bony defects can be achieved by the use of loupe magnifications. Loupes are easily portable, cheap and can thus be assembled even in the most remote of all places. Fibula has a relatively big caliber pedicle of about 2millimetre in diameter. This large size pedicle allows for the relatively ease of anastomosis with the loupes.