Fibula Osteocutaneous Flap Harvest
For surgical reconstruction of the face and neck, portions of skin and bone and associated blood vessels can be harvested from elsewhere on an individual's body, and transferred to the affected site with a low risk of tissue rejection. A portion of the fibula bone of the lower leg, and an adjacent flap of skin, can be used for reconstructing the mandible or maxilla.
The full case, with surgical footage of the procedure, can be viewed at TVASurg.ca A sample clip can be viewed below.
Content Experts
Ralph Gilbert, MD, FRCSC
Head and Neck Editor
Toronto General Hospital, University Health Network
Department of Otolaryngology, University of Toronto
David P. Goldstein, MD, FRCSC, FACS
Head and Neck Editor
Toronto General Hospital, University Health Network
Department of Otolaryngology, University of Toronto
Production
Modelling was done using Pixologic ZBrush and Cinema4D.
Animation in C4D, textures in ZBrush, shaders and rendering with Arnold, and compositing in Adobe After Effects.
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 Superficial layer of anterior lower leg anatomy, showing muscles of anterior compartment. |  Muscles of anterior compartment removed, revealing anterior vascular pedicle and interosseous membrane. |  Interosseous membrane divided longitudinally, revealing peroneal vascular pedicle travelling along medial surface of fibula. |
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Process
Critical to successful execution of this procedure is a thorough understanding of the muscular compartments of the lower leg and how the nerves and vasculature exist in relation to these spaces and the muscles and bones. Several sketches were done to better understand these relationships.
To aid in the teaching of this surgical narrative, a custom cross-section illustration was also produced and used for a discrete animation sequence unto itself. Surgeons often use CTs or MRIs as reference for surgical planning, so a cross-section is a format the intended audience will be intimately familiar with.
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For modelling, the strengths of two different modelling tools were employed. ZBrush was used for the muscles and bones, and sculpting of surface details. Blood vessels and nerves were modelled in Cinema4D using spline sweeps.
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