[Mandibular reconstruction by a free peroneal transfer]

After an anatomical study of the osteo-septo-cutaneous fibular flap, we reported 4 reconstructions of segmental mandible defects by this procedure, published in 1989 by D. Hidalgo. 2 patients presented mandibular defects associated with intraoral soft- tissue loss, following resection for epidermoid carcinoma with pre or post-operative radiation. The third patient had a multirecurrent ameloblastoma associated with extraoral soft-tissue extension. The fourth patient presented a complex loss of soft tissue and mandible following a war injury. The flaps survived in all patients. The osteo-septo-cutaneous fibular flap for mandible reconstruction has presented several advantages. The flap has been elevated under a tourniquet, the distant donor site has allowed a two-team approach. The osteo-septo-cutaneous blood supply has been adequate to support a skin island for intra or extraoral soft-tissue replacement. Biomechanical properties of the fibula have allowed fixation with miniplates and no postoperative intermaxillary fixation. Osteointegrated implants (Branemark) for dental rehabilitation were done for one patient. There was no long-term donor-site morbidity.