S. Lonie, P. Herle, A. Paddle, N. Pradhan, T. Birch et al., Mandibular reconstruction: metaanalysis of iliac-versus fibula-free flaps, ANZ J Surg. mai, vol.86, issue.5, pp.337-379, 2016.

J. Löfstrand, M. Nyberg, T. Karlsson, A. Thórarinsson, G. Kjeller et al., Quality of Life after Free Fibula Flap Reconstruction of Segmental Mandibular Defects, J Reconstr Microsurg. févr, vol.34, issue.2, pp.108-128, 2018.

S. Ferrari, M. Raffaini, B. Bianchi, and E. Sesenna,

, Minerva Stomatol. mars, vol.47, issue.3, pp.75-85, 1998.

T. A. Iseli, J. C. Yelverton, C. E. Iseli, W. R. Carroll, J. S. Magnuson et al., Functional outcomes following secondary free flap reconstruction of the head and neck, The Laryngoscope. mai, vol.119, issue.5, pp.856-60, 2009.

S. M. Roser, S. Ramachandra, H. Blair, W. Grist, G. W. Carlson et al., The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg, vol.68, pp.2824-2856, 2010.

S. Craig, E. Yuhasz, M. Shah, A. Blumberg, J. Salomon et al., Simulated surgery and cutting guides enhance spatial positioning in free fibular mandibular reconstruction, Microsurgery. janv, vol.35, issue.1, pp.29-33, 2015.

L. Ciocca, S. Mazzoni, M. Fantini, F. Persiani, C. Marchetti et al., CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery, J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg. déc, vol.40, issue.8, pp.511-515, 2012.

G. Zheng, Y. Su, G. Liao, Z. Chen, L. Wang et al., Mandible reconstruction assisted by preoperative virtual surgical simulation. Oral Surg Oral Med Oral Pathol Oral Radiol. mai, vol.113, pp.604-615, 2012.

P. Metzler, E. J. Geiger, A. Alcon, X. Ma, and D. M. Steinbacher, Three-dimensional virtual surgery accuracy for free fibula mandibular reconstruction: planned versus actual results, J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. déc, vol.72, issue.12, pp.2601-2613, 2014.

D. F. Zweifel, C. Simon, R. Hoarau, P. Pasche, and M. Broome, Are virtual planning and guided surgery for head and neck reconstruction economically viable?, J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. janv, vol.73, issue.1, pp.170-175, 2015.

W. Ren, L. Gao, S. Li, C. Chen, F. Li et al., Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap, Med Oral Patol Oral Cirugia Bucal. 1 mai, vol.23, issue.3, pp.359-66, 2018.

B. Sharaf, J. P. Levine, D. L. Hirsch, J. A. Bastidas, B. A. Schiff et al., Importance of computeraided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction, J Craniofac Surg. juill, vol.21, issue.4, pp.1277-80, 2010.

J. Weitz, K. Wolff, M. R. Kesting, and C. Nobis, Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg, vol.46, pp.1975-1983, 2018.

R. Gryseleyn, M. Schlund, P. Pigache, T. Wojcik, G. Raoul et al., Influence of preoperative imaging on fibula free flap harvesting, J Stomatol Oral Maxillofac Surg, vol.118, issue.5, pp.265-70, 2017.

K. E. Blackwell, Donor site evaluation for fibula free flap transfer, Am J Otolaryngol. avr, vol.19, issue.2, pp.89-95, 1998.

J. M. Smit, S. Klein, and P. Werker, An overview of methods for vascular mapping in the planning of free flaps, J Plast Reconstr Aesthetic Surg JPRAS. sept, vol.63, issue.9, pp.674-682, 2010.

S. P. Whitley, S. Sandhu, and A. Cardozo, Preoperative vascular assessment of the lower limb for harvest of a fibular flap: the views of vascular surgeons in the United Kingdom, Br J Oral Maxillofac Surg. août, vol.42, issue.4, pp.307-317, 2004.

F. Hölzle, O. Ristow, A. Rau, T. Mücke, D. J. Loeffelbein et al., Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment, Br J Oral Maxillofac Surg. juin, vol.49, issue.4, pp.275-80, 2011.

C. J. Wales, J. Morrison, R. Drummond, J. C. Devine, and J. Mcmahon, Pre-operative evaluation of vascularised fibula donor sites: a UK maxillofacial e-survey, Br J Oral Maxillofac Surg. avr, vol.48, issue.3, pp.192-196, 2010.

E. I. Chang, Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14-year review, Head Neck, vol.39, issue.7, pp.1454-1462, 2017.

S. A. Patel, H. Abdollahi, J. A. Ridge, E. I. Chang, M. N. Lango et al., Asymptomatic Deep Peroneal Vein Thrombosis During Free Fibula Flap Harvest: A Review of the Literature, Strategies for Preoperative Assessment, and an Algorithm for Reconstruction, Ann Plast Surg. avr, vol.76, issue.4, pp.468-71, 2016.

F. Vidal, Optimisation de la prise en charge anesthésique pour lambeaux libres : étude avant / après. Thèse d'exercice soutenue à l'Université de Caen, 2017.

M. L. Urken, Composite free flaps in oromandibular reconstruction. Review of the literature, Arch Otolaryngol Head Neck Surg. juill, vol.117, issue.7, pp.724-756, 1991.

D. Forner, B. A. Williams, F. M. Makki, J. R. Trites, S. M. Taylor et al., Late free flap failure in head and neck reconstruction: A systematic review, Ear Nose Throat J. juill, vol.97, issue.7, pp.213-219, 2018.

S. S. Shroff, S. C. Nair, A. Shah, and B. Kumar, Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study, J Maxillofac Oral Surg. mars, vol.16, issue.1, pp.101-108, 2017.

J. Van-gemert, J. H. Abbink, R. Van-es, A. Rosenberg, R. Koole et al., Early and late complications in the reconstructed mandible with free fibula flaps, J Surg Oncol. mars, vol.117, issue.4, pp.773-80, 2018.

J. S. Brown, J. C. Devine, P. Magennis, P. Sillifant, S. N. Rogers et al., Factors that influence the outcome of salvage in free tissue transfer, Br J Oral Maxillofac Surg. févr, vol.41, issue.1, pp.16-20, 2003.

I. Ahmadi, P. Herle, G. Miller, D. J. Hunter-smith, J. Leong et al., End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes, J Reconstr Microsurg. juill, vol.33, issue.6, pp.402-413, 2017.

E. G. Halvorson and P. G. Cordeiro, Go for the jugular: a 10-year experience with end-to-side anastomosis to the internal jugular vein in 320 head and neck free flaps, Ann Plast Surg. juill, vol.59, issue.1, pp.31-36, 2007.

G. Dimitropoulos, J. I. Efanov, L. Paek, J. Bou-merhi, and M. A. Danino, Comparison of venous couplers versus hand-sewn technique in free flap breast reconstruction, Ann Chir Plast Esthet. avr, vol.64, issue.2, pp.150-156, 2019.

M. Senthil-murugan, P. Ravi, M. Afradh, K. Tatineni, V. et al., Comparison of the efficacy of venous coupler and hand-sewn anastomosis in maxillofacial reconstruction using microvascular fibula free flaps: a prospective randomized controlled trial, Int J Oral Maxillofac Surg. juill, vol.47, issue.7, pp.854-861, 2018.

Y. Yamamoto, K. Nohira, H. Kuwahara, M. Sekido, H. Furukawa et al., Superiority of endto-side anastomosis with the internal jugular vein: the experience of 80 cases in head and neck microsurgical reconstruction, Br J Plast Surg. mars, vol.52, issue.2, pp.88-91, 1999.

R. C. Little, Physiology of the Heart and Circulation, 1981.

L. Bas, J. W. May, J. Handren, and J. Fallon, End-to-end versus end-to-side microvascular anastomosis patency in experimental venous repairs, Plast Reconstr Surg. mars, vol.77, issue.3, pp.442-50, 1986.

S. Bai, Z. Xu, W. Duan, F. Liu, D. Huang et al., Single Superficial versus Dual Systems Venous Anastomoses in Radial Forearm Free Flap: A Meta-Analysis, PloS One, vol.10, issue.8, p.134805, 2015.

Z. Han, J. Li, H. Li, M. Su, and L. Qin, Single versus dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction: a retrospective study. Microsurgery, vol.33, pp.652-657, 2013.

M. M. Hanasono, E. Kocak, O. Ogunleye, C. J. Hartley, and M. J. Miller, One versus two venous anastomoses in microvascular free flap surgery, Plast Reconstr Surg, vol.126, issue.5, pp.1548-57, 2010.

M. Enajat, W. M. Rozen, I. S. Whitaker, J. M. Smit, and R. Acosta, A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: investigating the effect on venous congestion and flap survival, Microsurgery, vol.30, issue.3, pp.185-91, 2010.

G. L. Ross, E. Ang, D. Lannon, P. Addison, A. Golger et al., Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis? Head Neck, août, vol.30, issue.8, pp.1086-1095, 2008.

S. Christianto, A. Lau, K. Y. Li, W. F. Yang, and Y. X. Su, One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis, Int J Oral Maxillofac Surg. mai, vol.47, issue.5, pp.585-94, 2018.

M. Y. Nahabedian, N. Singh, E. G. Deune, R. Silverman, and A. P. Tufaro, Recipient vessel analysis for microvascular reconstruction of the head and neck, Ann Plast Surg. févr, vol.52, issue.2, pp.156-157, 2004.

R. K. Khouri, B. C. Cooley, A. R. Kunselman, J. R. Landis, P. Yeramian et al., A prospective study of microvascular free-flap surgery and outcome, Plast Reconstr Surg. sept, vol.102, issue.3, pp.711-732, 1998.

M. Macnamara, S. Pope, A. Sadler, H. Grant, and M. Brough, Microvascular free flaps in head and neck surgery, J Laryngol Otol, vol.108, issue.11, pp.962-970, 1994.

D. Lidman and M. Niklasson, Survival and function in patients with tumours of the head and neck operated on and reconstructed with free flaps, Scand J Plast Reconstr Surg Hand Surg, vol.42, issue.2, pp.77-85, 2008.

S. J. Finical, W. G. Doubek, P. Yugueros, and C. H. Johnson, The fate of free flaps used to reconstruct defects in recurrent head and neck cancers, Plast Reconstr Surg. mai, vol.107, issue.6, pp.1363-1369, 2001.

D. Ehrl, P. I. Heidekrueger, M. Ninkovic, and P. N. Broer, Impact of Duration of Perioperative Ischemia on Outcomes of Microsurgical Reconstructions, J Reconstr Microsurg. juin, vol.34, issue.5, pp.321-327, 2018.

W. Wang, L. Huang, X. Gao, Y. Yuan, X. Chen et al., Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction, Int J Oral Maxillofac Surg. oct, vol.47, issue.10, pp.1263-1270, 2018.

N. Chernichenko, D. A. Ross, J. Shin, J. Y. Chow, C. T. Sasaki et al., Arterial coupling for microvascular free tissue transfer. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, vol.138, pp.614-622, 2008.

W. Zhou, W. Zhang, Y. Yu, Y. Wang, C. Mao et al., Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction, Int J Oral Maxillofac Surg. août, vol.46, issue.8, pp.941-946, 2017.

T. Rodi, A. Geierlehner, A. Mosahebi, G. Tanos, and J. Wormald, Protocol for a systematic review of venous coupler devices versus hand-sewn anastomosis for microsurgical free flap reconstruction, Syst Rev, vol.13, issue.1, p.186, 2018.

H. Umezawa, R. Ogawa, M. Nakamizo, K. Yokoshima, and H. Hyakusoku, A comparison of microsurgical venous anastomosis techniques, J Nippon Med Sch Nippon Ika Daigaku Zasshi, vol.82, issue.1, pp.14-20, 2015.

C. M. Chen, P. Ashjian, J. J. Disa, P. G. Cordeiro, A. L. Pusic et al., Is the use of intraoperative heparin safe?, Plast Reconstr Surg. mars, vol.121, issue.3, pp.49-53, 2008.

C. Couteau, K. Rem, D. Guillier, V. Moris, M. Revol et al., Improving free-flap survival using intra-operative heparin: Ritualistic practice or evidence-base medicine? A systematic review, Ann Chir Plast Esthet. juin, vol.63, issue.3, pp.1-5, 2018.

M. Abraham, A. Badhey, S. Hu, S. Kadakia, J. K. Rasamny et al., Thromboprophylaxis in Head and Neck Microvascular Reconstruction, Craniomaxillofacial Trauma Reconstr. juin, vol.11, issue.2, pp.85-95, 2018.

J. A. Ricci, K. Crawford, O. A. Ho, B. T. Lee, K. M. Patel et al., Practical Guidelines for Venous Thromboembolism Prophylaxis in Free Tissue Transfer, Plast Reconstr Surg, vol.138, issue.5, pp.1120-1151, 2016.

H. S. Ong, S. Gokavarapu, L. Al-qamachi, M. Y. Yin, L. X. Su et al., Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery, Head Neck, vol.39, issue.12, pp.2450-2458, 2017.

P. Ashjian, C. M. Chen, A. Pusic, J. J. Disa, P. G. Cordeiro et al., The effect of postoperative anticoagulation on microvascular thrombosis, Ann Plast Surg. juill, vol.59, issue.1, pp.39-40, 2007.

W. Chien, M. A. Varvares, T. Hadlock, M. Cheney, and D. G. Deschler, Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps, The Laryngoscope. juin, vol.115, issue.6, pp.973-979, 2005.

M. M. Hanasono, O. Ogunleye, J. S. Yang, C. J. Hartley, and M. J. Miller, Changes in blood velocity following microvascular free tissue transfer, J Reconstr Microsurg. sept, vol.25, issue.7, pp.417-441, 2009.

D. Culié, O. Dassonville, G. Poissonnet, J. Riss, J. Fernandez et al., Virtual planning and guided surgery in fibular free-flap mandibular reconstruction: A 29-case series, Eur Ann Otorhinolaryngol Head Neck Dis. juin, vol.133, issue.3, pp.175-183, 2016.

M. Tsai, H. Chuang, Y. Lin, H. Lu, W. Chen et al., Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction-a retrospective study, PeerJ, vol.6, p.4490, 2018.

M. T. Brands, S. C. Van-den-bosch, F. J. Dieleman, S. J. Bergé, M. Merkx et al., Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers, Int J Oral Maxillofac Surg. févr, vol.39, issue.2, pp.101-107, 2010.

S. Choi, D. L. Schwartz, D. G. Farwell, M. Austin-seymour, and N. Futran, Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer, Arch Otolaryngol Head Neck Surg, vol.130, issue.11, pp.1308-1320, 2004.

M. Ishimaru, S. Ono, S. Suzuki, H. Matsui, K. Fushimi et al., Risk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan, J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. juin, vol.74, issue.6, pp.1265-70, 2016.

A. Vincent, R. Sawhney, and Y. Ducic, Perioperative Care of Free Flap Patients, Semin Plast Surg. févr, vol.33, issue.1, pp.5-12, 2019.

E. Mahmoudi, Y. Lu, S. Chang, C. Lin, Y. Wang et al., Associations of Surgeon and Hospital Volumes with Outcome for Free Tissue Transfer by Using the National Taiwan Population Health Care Data from, Plast Reconstr Surg. sept, vol.140, issue.3, pp.455-65, 2001.

J. C. Devine, L. A. Potter, P. Magennis, J. S. Brown, and E. D. Vaughan, Flap monitoring after head and neck reconstruction: evaluating an observation protocol, J Wound Care. janv, vol.10, issue.1, pp.525-534, 2001.

E. I. Chang, H. Zhang, J. Liu, P. Yu, R. J. Skoracki et al., Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction, Head Neck, vol.38, issue.1, pp.771-775, 2016.

A. Bozec, G. Poissonnet, S. Converset, L. Lattes, E. Chamorey et al.,

A. Chir, Cervico Faciale Bull Soc Oto-Laryngol Hopitaux Paris. mars, vol.124, issue.1, pp.16-24, 2007.

J. N. Lodders, E. A. Schulten, . Jm, J. G. De-visscher, .. M. Forouzanfar et al., Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study, J Reconstr Microsurg. juill, vol.32, issue.6, pp.455-63, 2016.

J. M. López-arcas, J. Arias, D. Castillo, J. L. Burgueño, M. Navarro et al., The fibula osteomyocutaneous flap for mandible reconstruction: a 15-year experience, J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg, vol.68, issue.10, pp.2377-84, 2010.

S. A. Dowthwaite, J. Theurer, M. Belzile, K. Fung, J. Franklin et al., Comparison of fibular and scapular osseous free flaps for oromandibular reconstruction: a patient-centered approach to flap selection, JAMA Otolaryngol--Head Neck Surg. mars, vol.139, issue.3, pp.285-92, 2013.

A. O. Momoh, P. Yu, R. J. Skoracki, S. Liu, L. Feng et al., A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients, Plast Reconstr Surg. sept, vol.128, issue.3, pp.714-734, 2011.

. Remplissage, Faire bilan entrée/sortie mesurables. Règle générale : apports de base jusqu'à 3 ml/kg/h de cristalloïde (Ringer Lactate)

, Compenser les pertes sanguines par des macromolécules : Gélofusine* sans limite

, Voluven* maxi 50 ml / Kg soit : ????ml

, Hb : 7 g/dl. Patient ASA 1-2. Pas de tares. Hb : 8 g/dl. Patient âgé, polypathologique. Hb : 9 g/dl

, Réalimentation Par la SNG selon protocole nutritionniste

, Antioedémateux Solumédrol : 1,5mg/kg/j en IVL pendant 48 heures soit? mg

, Anti agrégant plaquettaire : KARDEGIC 160 mg par jour pendant 15 jours

. De-j-2-À-la-sortie, Soins : Position 1/2 assise, tête regardant en face

. Si-trachéotomie-de-décharge, canule : premier change à J3 ? canule acrylique sans ballonnet, pansement à refaire tous les jours, selon consignes. Soins de bouche : Aspiration douce et répétée de la stase salivaire et sanguine Soin doux au coton monté et bétadine* bain de bouche Si péroné : Appui autorisé avec béquilles dès J3

, Si chinois : Immobilisation du membre supérieur pendant 10 J

, Kinésithérapie mobilisatrice et respiratoire Bilan biologique : Ionogramme sanguin, NFS -plaquettes, TCA : Deux fois par semaine

, Antibiothérapie jusque cicatrisation pour ostéoradionécrose

, Si apparition de fièvre ? prélèvement bactériologiques locaux et hémocultures puis ROCEPHINE* : 2 g/ jour en IVL associé à FLAGYL* 1500 mg en une prise orale

&. Jusqu and . Post-op, Paracétamol 4g par jour, TRAMADOL 50 mg × 4/j associé à Oxynorm* 5 mg sublingual QS