Functional and aesthetic outcome with free fibula osteocutaneous flap in reconstruction of anterior mandibular defects in oral malignancies: our experience

Gopika Kalsotra, Disha Koul, Arti ., Parmod Kalsotra, Rupali Sharma, Aditya Saraf


Background: For anterior mandibular defects, vascularized bone flap reconstructions are the best for providing a solid arch necessary to restore form and function, especially in patients receiving tumour excision surgery in head and neck region. Our aim was to study aesthetic and functional outcome of free fibula osteocutaneous flap (FFOCF) in anterior mandibular defects in case of anterior floor of the mouth malignancies with mandibular infiltration.

Methods: The clinical data of 15 oral cavity carcinoma patients with involvement of anterior floor of mouth with mandiblular infiltration that underwent FFOCF reconstruction at our institute, government medical college, Jammu, was prospectively collected from January 2018 till January 2020. In this study, the aesthetic and functional outcome of these patients was evaluated at 6 months and 1 year post surgery.

Results: The aesthetic result of reconstruction was excellent in most patients. Also, there was no long-term donor-site morbidity. There was no peri-operative death. Flaps survived in all patients. Functional outcomes including the ability to tolerate oral diet and speech outcome were good in all cases.

Conclusions: The FFOCF, in reconstruction surgery of advanced oral cavity carcinoma permits more radical resection of tumour with good functional as well aesthetic outcome.


Reconstruction, Free flap, FFOCF, Oromandibular, Osteotomy

Full Text:



McCarthy CM, Cordeiro PG. Microvascular reconstruction of oncologic defects of the midface. Plast Reconstr Surg. 2010;126(6):1947-59.

Hidalgo DA. Fibular free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71-9.

Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg. 1999;104(5):1314-20.

Gilbert RW. Free flaps in head and neck reconstruction. In: Gleeson M, eds. Scott Brown’s otorhinolaryngology, head and neck surgery. 7th ed. Hodder Arnold publishers; 2008: 2867-90.

Peter WB, Stephen AS, Jarg-Erich H. Maxillofacial Surgery. 2nd ed. London: Churchill Living Stone Publication; 1999:527-8.

Fonceka RJ. Oral and Maxillofacial Surgery. 3rd ed. Philadelphia: Saunders Company; 2000: 364-5.

Wolff KD, Hözle F. Raising of microvascular flaps-a approach. 2nd ed. Berlin: Springer-Verlag Berlin Heidelberg; 2005: 107-37.

Parmar S. Defect based reconstruction: mandible and oral cavity. In: Watkinson JC, Gilbert RW, eds. Stell and Maran’s Textbook of head and neck surgery and oncology. 5th ed. Hodder Arnold publishers; 2012: 956.

Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg. 1999;104(5):1314-20.

Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience. ISRN Surg. 2011;2011:824251.

Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, et al. Oromandibular reconstruction using microvascular composite flaps. Arch Otolaryngol Head Neck Surg. 1998;124(1):46-55.

Reychler H, Ortabe JI. Mandibular reconstruction with the free fibula osteocutaneous flap. Int J Oral Maxillofac Surg. 1994;23(4):209-13.

Carr J, Macdonald DA,Waterhouse N. The blood supply of the osteocutaneous free fibular graft. J Bone Joint Surg Br. 1988;70(2):319-21.

Gedge DR, Singh NK. Devascularizing complications of free fibula harvest: peronea arteria magna. J Reconstr Microsurg. 2005;21(8):533-8.

Hidalgo DA, Rekow A. Review of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg. 1995;96(3):585-96.

Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994;93(2):294-304.

Frodel JL, Funk GF, Capper DT, Fridrich KL, Blumer JR, Haller JR, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg. 1993;92:449-55.

Wei FC, Chuang SS, Yim KK. The sensate fibula osteoseptocutaneous flap: a preliminary report. Br J Plast Surg. 1994;47(8):544-57.

Wei FC, Santamaria E, Chang YM, Chen HC. Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants. J Craniofac Surg. 1997;8(6):512-21.

Wei FC, Demirkan F, Chen HC, Chen IH. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg. 1999;103(1):39-47.

Wei FC, Yazar S, Lin CH, Cheng MH, Tsao CK, Chiang YC. Double free flaps in head and neck reconstruction. Clin Plast Surg. 2005;32(3):303-8.

Yazar S, Cheng MH, Wei FC, Hao SP, Chang KP. Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects. Head Neck. 2006;28(4):297-304.

Michael M, Ghali GE, Larsen PE, Waite PD. Peterson’s Principle of Oral and Maxillofacial Surgery. 2nd ed. London: BC Decker Inc; 2004: 811-2.

Carriquiry C, Aparecida CM, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg. 1985;76(3):354-63.

Schusterman MA, Reece GP, Miller MJ, Harris S. The osteocutaneous free fibula flap: is the skin paddle reliable? Plast Reconstr Surg. 1992;90(5):787-93.

Jones NF, Swartz WM, Mears DC, Jupiter JB, Grossman A. The double barrel free vascularized fibular bone graft. Plast Reconstr Surg. 1988;81(3):378-85.

Bidez MW, Misch CE. Force transfer in implant dentistry: basic concepts and principles. J Oral Implantol. 1992;18(3):264-74.

Horiuchi K, Hattori A, Inada I, Kamibayashi T, Sugimura M, Yajima H, et al. Mandibular reconstruction using the double barrel fibular graft. Microsurgery. 1995;16(7):450-4.

Abdel WAA. Osteocutaneous free fibular flap for anatomical reconstruction of the mandible following tumor resection. J Egypt Nat Cancer Inst. 2003;15(3):243-51.

Schrag C, Chang YM, Tsai CY, Wei FC. Complete rehabilitation of the mandible following segmental resection. J Surg Oncol. 2006;94(6):538-45.

Wei FC, Celik N, Chen HC, Cheng MH, Huang WC. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg. 2002;109(1):45-52.

Saleem M, Hashim F, Babu MM. Compartment syndrome in a free fibula osteocutaneous flap donor site. Br J Plast Surg. 1998;51(5):405-7.

Astarci P, Siciliano S, Verhelst R, Lacroix V, Noirhomme P, Rubay J, et al. Intra-operative acute leg ischaemia after free fibula flap harvest for mandible reconstruction. Acta Chirurgica Belgica. 2006;106(4):423-6.

Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004;114(6):1457-66.

Bodde EW, deVisser E, Duysens JE, Hartman EH. Donor-site morbidity after free vascularized autogenous fibular transfer: Subjective and quantitative analyses. Plast Reconstr Surg. 2003;111(7):2237-42.

Babovic S, Johnson CH, Finical SJ. Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests. J Reconstr Microsurg. 2000;16(2):107-10.

DeGraff A, DeLaeuw RJ, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA. Long-term quality of life of patients with head and neck cancer. Laryngoscope. 2000;110(1):98-106.