S140 –The Fibula Flap for Through and Through Oral Cavity Defects

Abstract

Objectives 1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances. Methods A retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined. Results 7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator-based skin paddle with a de-epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post-debridement with a PM flap. Conclusions While the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.