ORIGINAL ARTICLE BILOBED FIBULA FLAP FOR RECONSTRUCTION OF THROUGH-AND-THROUGH OROMANDIBULAR DEFECTS Meena Said, MD, Ryan Heffelfinger, MD, Joel A. Sercarz, MD, Elliot Abemayor, MD, PhD, Christian Head, MD, Keith E. Blackwell, MD Department of Surgery, Division of Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California. E-mail: kblackwe@ucla.edu Accepted 5 December 2006 Published online 21 February 2007 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20612 Abstract: Background. The role of fibula free flaps for recon- struction of through-and-through oromandibular defects is examined. Methods. Thirty-four patients underwent reconstruction of through-and-through oromandibular defects using fibula free flaps that contain large, bilobed skin paddles for simultaneous reconstruction of intraoral mucosa and external skin. We exam- ined the incidence of wound healing complications, the need for revision reconstructive surgery, and factors affecting the inci- dence of complications. Results. Wound healing complications occurred in 50% of patients. There was a relatively high incidence of partial flap ne- crosis (26%) and revision surgery (41%). The area of the flap skin paddle was significantly associated with the risk of partial flap necrosis and the need for revision surgery. Conclusions. Many through-and-through oromandibular defects can be successfully reconstructed using a fibula free flap that contains a large, bilobed skin paddle. However, wound healing complications are increased when the flap skin paddle area exceeds 300 cm 2 . V V C 2007 Wiley Periodicals, Inc. Head Neck 29: 829–834, 2007 Keywords: fibula flap; complications; mandible; reconstruction; necrosis Through-and-through oromandibular defects that include resection of the mandible, oral mu- cosa, and external skin represent a considerable challenge for reconstructive surgeons. Multiple options for reconstruction have been described, including the use of a single vascularized bone- containing free flaps that contain multiple soft tis- sue components, 1,2 the use of a free flap combined with a local or regional flap, 3,4 the use of 2 simul- taneous free flaps, 5,6 and even the use of 3 simul- taneous free flaps. 7,8 At many medical centers, the fibula free flap has become the most popular option for single stage, immediate reconstruction of segmental de- fects of the mandible. 9 This flap offers a bone graft that can replace any length of mandibular resec- tion, and the fibula readily accepts endosteal den- tal implants. The long-term donor site morbidity is acceptable in most patients after fibula flap har- vest. In addition, fibula flaps have long vascular pedicles that contain large diameter blood vessels, making them very reliable with a low incidence of complete flap failure. Despite the widespread pop- ularity of fibula flaps for mandibular reconstruc- tion, only 2 prior series in the literature that com- prised a total of 31 patients described the use of osteocutaneous fibula flaps for reconstruction of through-and-through oromandibular defects. 10,11 In these series, the results of reconstruction were Correspondence to: K. E. Blackwell V V C 2007 Wiley Periodicals, Inc. Bilobed Fibula Flap HEAD & NECK—DOI 10.1002/hed September 2007 829