Single flap reconstruction for complex oro-facial defects using chimeric free fibular flap variants.

In this article, we describe the use of chimeric free fibular flaps to reconstruct three-dimensional spatial defects in the orofacial region. Recent insights into permutations possible with the chimeric fibular flap have allowed us to achieve our reconstructive objectives with a single chimeric flap and minimise donor-site morbidity as well as operating time. In an overall series of 34 free fibular flaps from 2009 to 2012, we performed twelve cases of free chimeric fibular flaps with osseo-myo-cutaneous/OMC (n=7), multi-pedicled osseo-musculo-cutaneous/Mp-OMC (n=4) and multi-pedicled osseo-cutaneous/Mp-OC (n=1) variants for either post-excisional defects or osteo-radionecroses. We had an overall flap survival rate of 100% with one partial flap loss due to the 'puppeteer' effect. Based on our experiences, we find the chimeric fibular flap to be an excellent addition to our reconstructive arsenal for complex orofacial defects.