Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap.

Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment.

Results: The fibula free flap was split into proximal (80 cm) and distal (120 cm) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip.

Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap - one of the largest reported in the literature - as a single mode of reconstruction.