{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:47:06Z","timestamp":1779292026542,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T00:00:00Z","timestamp":1720569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cervical spine defects result in spinal instability, putting the spinal cord and vertebral arteries at risk of damage and possibly devastating neurological injuries. The fibula free flap can span the spinal defects for stability. There is a paucity of literature on this technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Multi\u2010institutional retrospective case series reviewing patients who underwent cervical spine reconstruction with a fibula free flap. Patient demographic information, comorbidities, characteristics of cervical spine defects, and free flap complications were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1187 fibula free flaps across 10 different institutions were reviewed. Thirteen patients (1.09%) underwent cervical spine reconstruction with a fibula free flap. Average age was 52.3\u2009years old with an age range of 12\u201379\u2009years. There were six males (46.1%) and seven females (53.8%). The most common defect etiology was infection (<jats:italic>n<\/jats:italic>\u2009=\u20096, 46.1%). Most commonly involved cervical spine level of the defect was C5 (<jats:italic>n<\/jats:italic>\u2009=\u200910) followed by C6 (<jats:italic>n<\/jats:italic>\u2009=\u20099) and C4 (<jats:italic>n<\/jats:italic>\u2009=\u20098). The majority of reconstructed defects spanned three or more cervical levels, (<jats:italic>n<\/jats:italic>\u2009=\u20099, 69.2%). Facial artery was the most common arterial anastomosis (<jats:italic>n<\/jats:italic>\u2009=\u20098). Eight patients (61.5%) required a tracheostomy during their postoperative course. None of the patients had symptomatic or radiographic nonunion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case series demonstrates that a vascularized fibula flap is a potential reconstructive option for cervical spine defects, especially in defects greater than three cervical levels, in the setting of infection, and previously radiated patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 134:4923\u20134928, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31625","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T08:56:45Z","timestamp":1720601805000},"page":"4923-4928","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fibula Free Flap Reconstruction of Cervical Spine Defects: A Multi\u2010Institutional Study"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-1421","authenticated-orcid":false,"given":"Sara","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Oregon Health and Science University  Portland Oregon U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoey","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddie","family":"Colcord","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Oregon Health and Science University  Portland Oregon U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan S.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Washington University School of Medicine in St. Louis  St Louis Missouri U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1103-6212","authenticated-orcid":false,"given":"Eric J.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Mayo Clinic  Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5035-4611","authenticated-orcid":false,"given":"Jason","family":"Thuener","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University Hospitals  Cleveland Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnaud F.","family":"Bewley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of California Davis  Sacramento California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Coughlin","sequence":"additional","affiliation":[{"name":"Department of Surgery Creighton University School of Medicine, Nebraska Methodist Hospital  Omaha Nebraska U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir S.","family":"Khariwala","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Minnesota  Minneapolis Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6588-6549","authenticated-orcid":false,"given":"Jeremy D.","family":"Richmon","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Massachusetts Eye and Ear  Boston Massachusetts U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrik","family":"Pipkorn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery Washington University School of Medicine in St. Louis  St Louis Missouri U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Winters","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery John Hunter Hospital  New Lambton Heights New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oleg N.","family":"Militsakh","sequence":"additional","affiliation":[{"name":"Department of Surgery Creighton University School of Medicine, Nebraska Methodist Hospital  Omaha Nebraska U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6856-8255","authenticated-orcid":false,"given":"Chad 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