The fat–fascia paddle only with a composite fibula flap: marked reduction in donor site morbidity

Abstract

Fibula free flaps are used widely in head and neck reconstruction, primarily for their versatility and contribution to aesthetic and functional outcomes. The literature suggests that early complications such as wound dehiscence and skin graft loss can occur in up to a third of patients. The healing of these donor sites can be prolonged, and in certain cases may require an operative intervention. A method to overcome this problem is described herein. In raising the skin paddle, a standard lateral approach to the fibula harvest is used. The skin paddle is not isolated and the posterior margin of the paddle is maintained. The skin paddle epithelium is separated with a small cuff of adipose tissue from the underlying fat–fascia layer. This fat–fascia paddle is then raised with the fibula as normal and tacked to the margins of the recipient soft tissue defect. The fat–fascia paddle heals, resulting in a thin mucosal covering for prosthetic dental rehabilitation. This technique can reduce the incidence of donor site wound complications when raising a composite fibula flap.