Impact of fibula osteoseptocutaneous flap laterality in mandibular and intraoral reconstruction

Background: The fibula flap has been the workhorse flap for mandibular re- construction. However, relationships among the bone, skin, and vessels raise concerns about donor-side selection. This study aimed to clarify its impact on clinical outcomes. Methods: Between September 2013 and June 2021, 61 cases of fibula osteoseptocutaneous flaps for mandibular and intraoral reconstruction were categorized into the landing-down (N = 25) and swing-up (N = 36) groups depending on whether the skin was easily accessible within the oral cavity. The demographics, operative findings, and outcomes of the cases were compared. Results: Overall, seven (11%) flaps developed skin necrosis, including four partial and three total necrosis. The skin necrosis rate was higher in the swing-up than in the landing-down group (19% vs. 0%, p = 0.035). Conclusions: When using the fibula osteoseptocutaneous flap for mandibular and intraoral reconstructions, ensuring that the skin is properly located within the oral cavity could reduce the risk of skin necrosis. (c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.