Secondary Reconstruction of Premaxilla With a π-Shaped Fibula Osteocutaneous Flap

Midface deformities due to oncologic bony defects are often difficult to secondarily correct. The authors herein report 2 cases of secondary reconstruction of an oncological premaxillary defect using a pi-shaped fibula osteocutaneous flap. The authors divided the fibula into 3 pieces and made it pi-shaped to reconstruct the curvature of the premaxilla. The palatal mucosal defect was closed with a skin paddle. The vascular pedicle was hooked up to the neck vessels either directly or by interposition of vessel grafts. Reconstruction was successful in both cases. The facial appearance was greatly improved, the palatal defects were closed, and the need for obturator prosthetics was eliminated. Immediate bony reconstruction is preferred for premaxilla defects. However, secondary reconstruction with a pi-shaped fibula osteocutaneous flap is a feasible option with high potential for improving aesthetic and functional outcomes.