Experience with Free Fibula Peroneal Osteofascial Flap for Composite Head and Neck Reconstruction

Introduction: The free fibular osteocutaneous flap has become the workhorse flap for reconstruction of the head and neck when bony support and soft tissue coverage and/or mucosal lining are needed. However, the donor site often requires skin grafting and is a potential site for additional complications and increased morbidity. Here, we describe the free fibula osteofascial flap as a reliable option for composite head and neck reconstruction that allows for primary closure of the donor site defect. Materials and Methods: Preliminary results on four patients undergoing mandible reconstruction with free fibula fascia flaps at the University of California San Francisco were evaluated and included in our study. Medical records were reviewed for demographics, comorbidities, oncologic and reconstructive operations, and postoperative complications. Results: Four patients with squamous cell carcinoma of the oral cavity underwent segmental mandibulectomy with radical neck dissections and were reconstructed using the free fibula osteofascial flap. The soleus/peroneal fascia was dissected from the skin and muscle while preserving the perforators which were included in the composite flap in all patients. Two patients were found to have no cutaneous perforators that would have supported a skin paddle. Fibular osteotomies were performed using custom made templates for mandibular reconstruction. The soleus/peroneal fascia was use to reconstruct the floor of mouth and provide coverage of the bony construct and hardware. The fascia was left to mucosalize, and the donor sites were closed primarily and healed in all cases without complication. There were no flap related complications. Conclusions: The free fibula osteofascial flap is a refinement of the traditional free fibula osteocutaneous flap and provides suitable bone length along with a reliable piece of fascia that can be used to reconstruct bony defects as well as provide soft tissue for coverage and lining. The donor site can then be closed primarily thereby precluding the need for skin grafting and associated donor site complications. While this flap is not indicated for every composite head/neck reconstruction, it represents an innovative option in the reconstructive surgeon's armamentarium.