Fibula Osteoseptocutaneous Flap Research Articles

Toe Flexion Contracture after Vascularized Fibula Osteoseptocutaneous Harvest-Possible Etiology and Surgical Management

Free vascularized fibular osteoseptocutaneous flap has been widely used in head and neck reconstruction. Donor site morbidity from harvesting fibular flap is mild and infrequent. However, toe flexion contracture can be a bothersome complication of this procedure. The possible etiology and surgical management are explored. Between 1999 and 2003, the patients subjected to free osteoseptocutaneous fibula flap for head and neck defects were retrospectively reviewed. The patients who experienced toe flexion contractures following fibula flap harvest were analyzed and a management plan was proposed. The severity of the deformity was rated as mild, moderate and severe grade. Corrective surgery was suggested in moderate and severe forms. Out of 149 patients, seven cases (5%) experienced variable toes flexion deformity. There were 3 severe, 6 moderate and 1 mild toes flexion deformity. Lengthening of flexor tedon longus was performed at the interphalangeal level. We have performed lengthening in 7 toes because one case was mild deformity in big toe and another case with deformity in big and second toe refused surgery due to underlying disease. The average of post operative follow-up time was 15.4 months (ranged 4 to 36 months). Functional improvement was attained in six of seven toes. There was also no post-operative wound healing problem. In conlusion, we think corrective procedure of tendon lengthening over interphalageal level is an effective method to resolve the deformity.

Fibula Osteoseptocutaneous Flap with a Variant Perforator and Peroneal Artery Arising from the Anterior Tibial Artery

Since the report of the first cases of vascularized free fibula graft for treatment of open fracture of the tibia and fibula in 1975, there have been many other reports of the use of vascularized free osteocutaneous fibula flaps for reconstruction of the mandible or lower leg. Usually, these flaps have a single pedicle composed of the peroneal artery, to supply the fibula with septocutaneous or musculocutaneous branches arising from the peroneal artery to supply the lateral skin of the leg. Although some authors have reported variant perforators, there have been no reports of the peroneal artery arising from the anterior tibial artery and perforator arising from the posterior tibial artery. This is the first report of a variant of the peroneal artery and perforator using a vascularized free osteocutaneous fibula flap.

One-Stage Reconstruction of Composite Bone and Soft-Tissue Defects in Traumatic Lower Extremities

Management of bone loss that occurs after severe trauma of open lower extremity fractures continues to challenge reconstructive surgeons. Sixty-one patients who had 62 traumatic open lower extremity fractures and combined bone and composite soft-tissue defects were treated with the following protocol: extensive debridement of necrotic tissues, eradication of infection, and vascularization of osteocutaneous tissue for one-stage bone and soft-tissue coverage reconstruction. The mechanism of injury included 49 motorcycle accidents (80.3 percent), five falls (8.2 percent), three crush injuries (4.9 percent), two pedestrian-automobile accidents (3.3 percent), and two motor vehicle accidents (3.3 percent). The bone defects were located in the tibia in 49 patients (79 percent; one patient had bilateral open tibial fractures), in the femur in seven patients (11.3 percent), in the calcaneus bone in four patients (6.5 percent), and in the metatarsal bones in two patients (3.2 percent). The size of soft-tissue defects ranged from 5 x 9 cm to 30 x 17 cm. The average length of the preoperative bony defect was 11.7 cm. The average duration from injury to one-stage reconstruction was 27.1 days, and the average number of previous extensive debridement procedures was 3.4. Fifty patients had vascularized fibula osteoseptocutaneous flaps, six had vascularized iliac osteocutaneous flaps, and five patients had seven combined vascularized rib transfers with serratus anterior muscle and/or latissimus dorsi muscle transfers. One patient received a second combined rib flap because the first combined rib flap failed. The rate of complete flap survival was 88.9 percent (56 of 63 flaps). Two combined vascularized rib transfers with serratus anterior muscle and latissimus dorsi muscle flaps were lost totally (3.2 percent) because of arterial thrombosis and deep infection, respectively. Partial skin flap losses were encountered in the five fibula osteoseptocutaneous flaps (7.9 percent). Postoperative infection for this one-stage reconstruction was 7.9 percent. Excluding the failed flap and the infected/amputated limb, the primary bony union rate after successful free vascularized bone grafting was 88.5 percent (54 of 61 transfers). The average primary union time was 6.9 months. The overall union rate was 96.7 percent (59 of 61 transfers). The average time to overall union was 8.5 months after surgery. Seven transferred vascularized bones had stress fractures, for a rate of 11.5 percent. Donor-site problems were noted in six fibular flaps, in two iliac flaps, and in one rib flap. The fibular donor-site problems were foot drop in one patient, superficial peroneal nerve palsy in one patient, contracture of the flexor hallucis longus muscle in two patients, and skin necrosis after split-thickness skin grafting in two patients. The iliac flap donor-site problems were temporary flank pain in one patient and lateral thigh numbness in the other. One rib flap transfer patient had pleural fibrosis. Transfer of the appropriate combination of vascularized bone and soft-tissue flap with a one-stage procedure provides complex lower extremity defects with successful functional results that are almost equal to the previously reported microsurgical staged procedures and conventional techniques.

Maxillary Reconstruction with a Fibula Osteoseptocutaneous Free Flap and Simultaneous Insertion of Osseointegrated Dental Implants

The fibula osteoseptocutaneous flap is a good option for reconstruction of three-dimensional composite maxillary defects. This flap provides both bone and soft-tissue reconstruction and allows osseointegrated dental implantation, either simultaneously or in a second-stage procedure. Simultaneous placement of osseointegrated dental implants reduces operative sessions and allows faster oral rehabilitation for properly selected patients. The defects may result from trauma or resection of benign tumors or low-grade malignancies. Between August of 1999 and July of 2001, three patients underwent maxillary reconstruction with the fibula osteoseptocutaneous flap and simultaneous osseointegrated dental implants. The cause of the defect was trauma in two cases and resection of an adenoid cystic carcinoma in the other. The mean length of the fibula used for bony reconstruction was 4.7 cm. One osteotomy was performed in one case and no osteotomy was necessary in the other two. Skin islands of 8 x 2.5 cm and 16 x 3.5 cm were used for two patients. For the other patient, a double skin island was used for both nasal (6 x 4 cm) and oral (6 x 5 cm) reconstructions. Two osseointegrated implants were inserted into the fibular bone for each patient. Six months after the first-stage procedure, palatal rotation flaps or mucosa grafts were used to cover the exposed implant necks and prepare the implants for prostheses. One month after the second-stage procedure, prostheses were placed. An implant-supported prosthesis was used for one patient and implant/tissue-supported prostheses were used for the others. At a mean follow-up time of 30 months (range, 16 to 38 months), all patients were able to use the dental prosthesis for chewing (beginning 6 weeks after the final procedure) and all patients were satisfied with the cosmetic results.

Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft.

Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993-2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16-65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6-13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10-93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5-8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna.

Reconstruction of lower limb bone defects after sarcoma resection in children and adolescents using free vascularized fibular transfer.

This study included 11 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap and their surgery performed at least 24 months before the end of the study. The average age at operation was 14.4 years. All tumors, except one, were high-grade sarcomas (stage IIA, IIB, and Ewing's sarcoma). The tumor volume averaged 200.6 cm3 (range 41.5-400). The resulting defect after tumor resection averaged 14.8 cm (range 9-20). The fibula was inserted as a single strut in eight patients and as a double-barrel construct in three patients. Fixation was augmented by interlocking nail in four cases, bridge plate in five cases and external fixator in two cases. All flaps survived. All grafts united in an average period of 3.9 months (range 3-8) after transfer. Full weightbearing was possible after an average period of 6 months (range 6-10). Significant hypertrophy (>/=30% of the original fibular diameter) occurred in all patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean 38 months), the degree of hypertrophy averaged 96.6% (range 30-200%). Graft fracture occurred in one patient after plate removal and healed conservatively. Shortening averaged 1 cm (range 0-3). The Musculoskeletal Tumor Society rating score averaged 21 points at the end of the first postoperative year and 23 at the end of the study.

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

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.

Osteoradionecrosis of the Mandible after Oromandibular Cancer Surgery

Although postoperative radiotherapy has proved effective in improving local control and survival in patients with head and neck cancers, its complications, especially mandibular osteoradionecrosis, reduce the quality of life. Mandibular surgery before the radiotherapy adds an additional risk factor for osteoradionecrosis. This study reviews patients in Chang Gung Memorial Hospital, Taipei, Taiwan, over a 10-year period, who underwent intraoral cancer resection followed by postoperative radiotherapy and thereafter developed osteoradionecrosis of the mandible. A total of 24 men and three women with a mean age of 49.9 years were identified and included in the study. In 10 cases, tumor resection was performed with a marginal mandibulectomy; in eight cases, tumor resection was performed after mandibular osteotomy; and in three cases, a segmental mandibulectomy was performed, and the defect was reconstructed with a fibula osteoseptocutaneous flap. In six cases, tumor excisions were performed without interfering with the mandibular continuity. Patients received postoperative external beam radiotherapy into the primary site and the neck, with a mean dose (+/-SD) of 5900 +/- 1300 cGy in an average of 35 fractions during an average of 6.5 weeks. The average elapsed time between the end of radiation therapy and clinical diagnosis of osteoradionecrosis of the mandible was 11.2 months (range, 2 to 36 months). The time elapse between the end of the radiation therapy and the diagnosis of osteoradionecrosis was influenced by initial treatment (Kruskal-Wallis test: n = 27, chi-square = 12.884, p < 0.005), and this period was shorter if the mandibular osteotomy or marginal mandibulectomy was performed (the two lowest mean ranks in the test). However, if the initial surgery resulted in a segmental mandibulectomy reconstructed with a fibula osteoseptocutaneous flap, onset of the osteoradionecrosis was relatively late (Kruskal-Wallis test: n = 21, chi-square = 7.731, p = 0.052). After resection of osteoradionecrotic bone and surrounding soft tissue, 22 patients underwent reconstructive procedures with a fibula osteoseptocutaneous flap, and five patients underwent reconstructive procedures with an inferior genicular artery osteoperiosteal cutaneous flap. One fibula osteoseptocutaneous flap showed total failure and another showed a 25 percent skin loss; both were revised with pedicled flaps. The skin paddle of an inferior genicular artery flap was replaced with an anterolateral thigh flap because of anatomic variation of the skin vessel. Once the diagnosis of osteoradionecrosis is established, replacement of the dead bone and surrounding tissue with a vascularized free bone flap is inevitable, and a composite osteocutaneous free flap is a good option.

Hypertrophy after free vascularized fibular transfer to the lower limb.

This study included 25 patients with lower limb tumors who had reconstruction by vascularized fibula osteoseptocutaneous flap performed at least 24 months before the end of the study. Hypertrophy of the transplanted fibula was estimated on serial radiographs by a modification of the formula of De Boer and Wood (J Bone Joint Surg [Br] 71:374-378, 1989). A significant graft was observed in 90% of the patients at an average follow-up of 27 months (range, 30-200%). The time to graft union (start of partial weight-bearing) positively correlated with the time to significant graft hypertrophy (r = 0.9, P < 0.01). The final amount of graft hypertrophy was affected by the age of the patient (P < 0.01) and the length of follow-up (P < 0.05). Graft hypertrophy progressed at an average rate of 3.3% per month (range, 2.3-4.9%) until the end of the 30th month; thereafter, little or no increase in graft hypertrophy was observed. The rate of graft hypertrophy showed two significant peaks at 6-12 months (P < 0.001) and at 18-24 months (P < 0.05). Patients younger than age 20 years showed faster hypertrophy, with a peak at the 12th month. Hypertrophy progressed faster in patients who received chemotherapy until the 12th month, and then declined sharply compared to those who did not receive chemotherapy.

Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap.

This study included 25 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap, and who had their surgery performed at least 24 months before the end of the study. The average age at operation was 23.5 years. Twenty-three tumors were malignant;16 were staged as high-grade sarcomas (stage IIA, stage IIB, and Ewing's sarcoma). Tumor volume averaged 293.2 cc (range, 41.4-860). The resulting defect after tumor resection averaged 16 cm (range, 9-20 cm). The fibula was inserted as a single strut in 21 patients, and as a double-barrel construct in 4 patients. Fixation was augmented by interlocking nail in 11 cases, bridge plate in 9 cases, and external fixator in 5 cases. Twenty-four (96%) flaps survived. All grafts united in an average period of 4.5 months (range, 3-8 months) after transfer. Two secondary procedures were necessary to achieve graft union. Full weight bearing was possible after an average period of 7.5 months (range, 5-14 months). Significant hypertrophy (> or =30% of original fibular diameter) occurred in 85% of patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean, 32 months), the degree of hypertrophy averaged 90% (range, 30-200%). Graft fracture occurred in three patients, and all healed conservatively. The Musculoskeletal Tumor Society rating score (MTSRS) averaged 21.2 points at the end of the first postoperative year, and 23.6 at the end of the study.

Mandibular Reconstruction with Fibula Osteoseptocutaneous Free Flap and Osseointegrated Dental Implants

The fibula osteoseptocutaneous free flap is ideal for reconstruction of composite mandible defects. Osseointegration is possible and advantageous. Primary osseointegration of dental implants is a safe and reliable procedure in selected groups of patients, promoting early total oral rehabilitation with restoration of both function and cosmesis. Further studies are necessary to assess the specific indications for osseointegration teeth in patients with malignant tumors and in those patients who have received radiation therapy.

Radial forearm and fibula free flap reconstruction after radical resection of head and neck malignancies

The incidence of head and neck cancer has been rapidly increasing in Hungary during the last decade. Most of these tumors are discovered in advanced stage, consequently, surgical removal of the tumor results in large complex defects in the soft tisses and bone elements of the face and neck. For optimal anatomical and functional reconstruction we perform free flap transfer in increasing number of cases. Between December 1993 and March 2001 in the Head and Neck Surgery Department of the National Institute of Oncology the defects after resection of head and neck tumors were reconstructed with free flaps in 85 cases. Radial forearm flap in 64 cases, fibula osteoseptocutaneous flap in 14 cases were used. In 87% of the patients the postoperative period was uneventful, the surgical complications were not more numerous than following traditional reconstructions. The average duration of operations became shorter by 2.5 hours during the last two years than before. In most of the cases we achieved good functional and esthetic results. The quality of life of the patients was excellent in 14%, almost normal in 73% and bad with serious problems of social life in 13%. It is surprising that there was no significant difference between the survival of neck node positive and negative patients. In our practice the replacement of large defects in the head and neck region with free flaps is a reliable and useful method for reconstruction.

Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases.

To evaluate the value of routine preoperative angiographies of donor sites, 120 patients with free fibula osteoseptocutaneous flap transplantations were included in this prospective study, which consisted of preoperative evaluation of dorsalis pedis and tibial posterior artery pulsation and angiographies of the donor legs (120 patients) and contralateral legs (111 patients). Both pedal pulses were palpable in 114 patients, and only one pulse was palpable in six patients. The respective nonpalpable foot pulses were detectable with pencil Doppler in five patients, but they were not detectable in one patient. Intraoperatively, the latter patient had a relatively hypertrophied peroneal artery as compared with both the tibial posterior and tibial anterior arteries. The angiographic result was arteria peronea magna. The other five patients showed intraoperatively and angiographically normal-sized major arteries of the lower leg. In three patients with normal pedal pulses, hypoplasias of either the tibial anterior or tibial posterior arteries were found intraoperatively. These findings corresponded with the angiographical results. In all patients (n = 119), except one with peroneal artery hemangioma, free osteoseptocutaneous fibula flap was harvested from the originally planned leg without subsequent sequelae to the respective donor leg. In 231 leg angiographies, only 7 cases (3 percent) with abnormalsized major lower leg arteries were described. The diagnoses in these cases were hypoplasia of either the tibial posterior or tibial anterior artery (4 cases), arteria peronea magna (2 cases, one of which was a false positive), absence of peroneal artery combined with hypoplastic tibial posterior artery (1 case), and hemangioma of the peroneal artery (1 case). From this prospective study, it was determined that routine preoperative angiography of the donor leg before fibula transplantation is not justified. It does not add relevant new information about donor leg vascularity, provided that the clinical evaluation of the pedal pulses is well conducted. The only two conditions that may require a preoperative donor leg angiography are abnormal pedal pulses or significant previous lower leg trauma.

Primary Insertion of Osseointegrated Dental Implants into Fibula Osteoseptocutaneous Free Flap for Mandible Reconstruction

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time. (Plast. Reconstr. Surg. 102: 680, 1998.)

Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction.

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.

The fibula osteoseptocutaneous flap combined with simultaneous or secondary implantation in oro-mandibular reconstruction

The fibula osteoseptocutaneous flap combined with simultaneous or secondary implantation in oro-mandibular reconstruction

Ulnar adamantinoma: En bloc excision and fibular osteoseptocutaneous free flap reconstruction

Adamantinoma is a rare tumor of the appendicular skeleton, and only six cases of ulnar involvement have been reported. We present the case of a 58-year-old man who sustained a pathologic fracture of the proximal third of his right ulna. Biopsy at the time of intramedullary fixation revealed adamantinoma, and he was referred for treatment. There was no evidence of metastatic disease. At operation, the proximal 22 cm of ulna was excised en bloc and the defect reconstructed using a vascularized fibular osteoseptocutaneous flap. The postoperative course was uneventful, and the patient has remained free of disease with very good function 3 years later.

Fibula Osteoseptocutaneous Flap for Reconstruction of Composite Mandibular Defects

The fibula osteoseptocutaneous flap is a versatile method for reconstruction of composite-tissue defects of the mandible. The vascularized fibula can be osteotomized to permit contouring of any mandibular defect. The skin flap is reliable and can be used to resurface intraoral, extraoral, or both intraoral and extraoral defects. Twenty-seven fibula osteoseptocutaneous flaps were used for composite mandibular reconstructions in 25 patients. All the defects were reconstructed primarily following resection of oral cancers (23), excision of radiation-induced osteonecrotic lesions (2), excision of a chronic osteomyelitic lesion (1), or postinfective mandibular hypoplasia (1). The mandibular defects were between 6 and 14 cm in length. The number of fibular osteotomy sites ranged from one to three. All patients had associated soft-tissue losses. Six of the reconstructions had only oral lining defects, and 1 had only an external facial defect, while 18 had both lining and skin defects. Five patients used the skin portion of the fibula osteoseptocutaneous flaps for both oral lining and external facial reconstruction, while 13 patients required a second simultaneous free skin or musculocutaneous flap because of the size of the defects. Four of these flaps used the distal runoff of the peroneal pedicles as the recipient vessels. There was one total flap failure (96.3 percent success). There were no instances of isolated partial or complete skin necrosis. All osteotomy sites healed primarily. The contour of the mandibles was good to excellent.

The sensate fibula osteoseptocutaneous flap: a preliminary report

The ideal oromandibular reconstruction calls for restoration of intraoral sensation as well as tissue replacement because the loss of sensation in the oral cavity impairs oral function. The versatility and flexibility of the fibula osteoseptocutaneous flap in complex three dimensional spatial positioning lends itself to be desirable in composite oromandibular reconstruction. It falls short of being ideal because the skin paddle of the flap is usually insensate and thus oral sensation is not restored. The skin paddle of the fibula osteoseptocutaneous flap is innervated by the lateral sural cutaneous nerve and this nerve can be preserved and reinnervated to restore sensation to the skin paddle. The sensate fibula osteoseptocutaneous flap may be the ideal flap for one stage composite reconstruction of oromandibular defects. This is a preliminary report on the sensory return of the sensate fibula osteoseptocutaneous flap in oromandibular reconstruction.

Fibula osteoseptocutaneous free flap in maxillary reconstruction

The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings. The flexibility of the fibula in three-dimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. The fibula osteoseptocutaneous flap is suitable for one-stage reconstruction of composite maxillary defects. The unique characteristics of the fibula osteoseptocutaneous flap and its application in the one-stage composite maxillary defect are discussed.