Selection of the Donor Site in Mandibular Reconstruction Using Osteocutaneous Fibula Flaps

Reconstruction of the mandible has been challenging for the reconstructive surgeon. The free osteocutaneous fibula flap has many advantages and it has frequently been used. The survival of the free flap depends on the location of the fibula, skin island, and anastomosed vessels. In this paper, the authors reported their findings on the relationship of defect and donor side.

From July 2002 to March 2004, there were 15 cases of mandible reconstruction using free fibula osteocutaneous flaps. There were 12 male and three female patients, with a mean age of 55.2 years. In applying free osteocutaneous fibula flaps, four types were identified, based on the location of the skin island and vascular pedicle. Type 1: The skin island is fixed to the oral cavity and the vascular pedicle runs anteriorly (n = 5). Type 2: The skin island is fixed to the oral cavity and the vascular pedicle runs posteriorly (n = 5). Type 3: The skin island is fixed to the facial skin and the vascular pedicle runs anteriorly (n = 4). Type 4: The skin island is fixed to the facial skin and the vascular pedicle runs posteriorly (n = 1). The free fibula osteocutaneous flaps were harvested from either the contra- and ipsilateral legs, depending on the location of the skin island and vascular pedicle. All transferred flaps survived completely, except for one partial necrosis.

During a mean 21-month follow–up period, major fistula formation that required additional surgery occurred in two patients, and minor fistula formation that healed conservatively occurred in three patients. A good survival rate was obtained. It is essential for the reconstructive surgeon to take into account the skin defect and anastomosis site in selecting the donor site in mandibular reconstruction.