Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach.

The fibula flap is a workhorse flap for bony reconstruction of oro-mandibular area and can be modified to include soft tissue for reconstruction of composite defects. However, the design of a reliable skin paddle that can be used for composite tissue reconstruction remains a challenge. The authors described the applicability of perforator concept for a more reliable free osteomusculocutaneous fibula flap.Between 2013 and 2015, 29 patients underwent free fibula osteocutaneous flap reconstruction. Twenty-two patients have been operated due to squamous cell carcinoma and 7 patients due to gunshot injuries.The mean harvesting time was 60 ± 15 minutes. The range of width of the skin paddle was 3 to 12 cm and length was 6 to 23 cm. The range of length of bone was 5 to 18 cm. One patient had revision due to venous occlusion. All flaps have survived.The authors advocate approaching all components of flap individually using the perforator concept and dissection. Good exposure is mandatory for a reliable dissection. In our opinion, the posterior approach is more useful as it reveals all vascular relationships between the bone, muscle, skin paddle, and peronel vessels.