Technical considerations of fibular osteocutaneous flap dissection

Fibula flap dissection is a reliable, often first-choice, means of osteocutaneous free tissue transfer. Experience from many centres has shown this flap to be ideally suited to the reconstruction of mandibular defects, which is its main indication in our unit. Despite its popularity, harvesting the fibula osteocutaneous flap remains technically challenging. We describe modifications of the standard flap dissection technique which we employ in our unit. In our hands, these help to simplify the dissection of the flap pedicle and maximise the pedicle length available for microvascular anastomoses. This has helped to ensure that the flap can be raised safely and expediently.