Harvest and clinical application of the fibula flap

The fibula flap has become one of the most popular composite free flaps for mandibular reconstruction. It provides sufficient bone length to reconstruct any mandibular defect and sufficient volume to consistently accept osseointegrated implants for dentures. The donor site is remote from the head and neck, allowing synchronous double team surgery. The skin paddle is quite reliable and has neurosensory potential. Optional muscle paddles of soleus or flexor hallucis longus muscles, or both, provide choices for closing combined intra- and extraoral defects. Donor morbidity associated with this flap is very low. The relatively short vascular pedicle can be lengthened by modifying the bone flap. The large caliber of the pedicle vessels facilitates microvascular anastomoses. This flap has many advantages over current flap options for the repair of various oromandibular defects.