Management of Skin Paddle without Visible Sizable Perforator in the Fibula Osteoseptocutaneous Flap for the Mandibular Reconstruction after Cancer Ablation-Two Cases Report

Abstract

The reliability of the fibula osteocutaneous flap is still controversial. Most authors suggested discarding the skin paddle immediately when the harvested skin paddle lacks sizable perforators. Herein, we report two cases without sizable perforator of skin paddles of the fibula osteocutaneous flaps (skin paddle 12×4 and 10×5 cm in size) for mandibular and buccal defects reconstruction. Although not well vascularized, the skin paddle was retained for intraoral lining temporarily on a wait and see policy, and served as a biological barrier to prevent the salivary from pooling around the vacularized bone graft. The skin paddle was removed two weeks later due to complete devascularization. Spontaneous mucosalization developed to resurface the fibula bone graft uneventfully; no further reconstruction was needed.