Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap.

BACKGROUND

A double island free fibula (DIFF) flap can be used for reconstruction of through-and-through or complex mandibulectomy defects, but prospective studies are lacking.

METHODS

Prospective analysis of all double skin paddle fibula flaps performed from 2010 to 2016.

RESULTS

Overall, 16 patients underwent reconstruction with a DIFF flap (average age: 59.1 years). One patient, who underwent a DIFF flap and developed osteoradionecrosis, requiring a second flap. Thirteen patients were males, and 7 had a history of smoking, 13 had prior radiation, and 14 had prior chemotherapy. The most common primary pathology was squamous cell carcinoma (n = 13). Reconstruction using the DIFF was predominantly for mandible reconstruction with one patient undergoing reconstruction following a orbitomaxillectomy. Complications included infection (n = 2), hematoma (n = 1), and donor site complications were limited. Two patients developed venous congestion requiring re-exploration, and both flaps were successfully salvaged. One patient lost the external skin paddle requiring a pectoralis muscle flap, and there were no total flap losses.

CONCLUSIONS

The DIFF flap is a reliable option that can reconstruct complex composite defects often obviating the need for a second free flap, thereby decreasing operating time, added donor site morbidity, and the need for additional recipient vessels.