EXPERIENCE WITH THE OSTEOCUTANEOUS FIBULA FLAP - AN ANALYSIS OF 24 CONSECUTIVE RECONSTRUCTIONS OF COMPOSITE MANDIBULAR DEFECTS

Based on findings from anatomical dissections of the skin supply of th e peroneal artery, we used the osteocutaneous fibula flap for combined replacement of the mandible and floor of the mouth in 24 patients, fr om November 1993 to December 1995. There were 22 primary and 2 seconda ry reconstructions; the mean age of the patients (2 women and 22 men) was 64 years. The length of the fibula segments ranged between 5.5 and 18 cm, the size of the skin component between 3 x 5 and 6 x 15 cm, Co rresponding to the results of our anatomical studies, the skin island was exclusively raised from the distal third of the lower leg, and the donor sites were generally covered with split thickness skin grafts. The average length of the dissected vascular pedicle was 11 cm, so tha t a vein graft was only required in one case, Flap raising and tumour resection sere always carried out simultaneously. Fibula osteosynthesi s was done with titanium miniplates; the insertion of endosseous impla nts followed secondarily. The success rate was 95.8% with one transpla nt loss and pseudarthrosis in one case, Despite the limited width of t he fibula, the shape of the mandible was satisfactorily reconstructed in all patients, and the thin, pliable skin component enabled intraora l coverage with only negligible surplus volume. Chronic wound-healing disturbances at the donor site of the skin island occurred in two case s; impairment of walking ability was not detected, According to our ex perience, the use of the osteocutaneous fibula flap is a valuable meth od for the reconstruction of composite mandibular defects.