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Published on: December 5, 2025
Fibula osteo-adipofascial flap for mandibular and maxillary reconstruction
Mark L Smith1, Emily Clarke-Pearson, Joseph H Dayan
1Department of Surgery, Beth Israel Medical Center, New York, New York, USA. MSmith@chpnet.com
Background:
The fibula free flap is a reliable method for reconstructing composite head and neck defects. However, its skin paddle has drawbacks, including its thickness, hair-bearing surface, desquamation, difficulty insetting it into maxillary defects, and the potential need for skin-grafting the donor site. The fibula osteo-adipofascial flap (FOAFF) is a modification of the fibula flap that overcomes these problems.
Methods:
A retrospective study of 6 consecutive patients who underwent FOAFF reconstruction was evaluated for outcomes and complications.
Results:
The mean follow-up was 22.6 months. All flaps survived, with complete oral mucosalization by 7 weeks. Four patients had dental implants placed at the time of reconstruction. Two patients received radiation therapy. Aside from loss of the labial sulcus in anterior maxillary reconstructions, complications were negligible.
Conclusion:
The FOAFF is useful for reconstructing defects requiring bone, soft tissue, and mucosal replacement without the disadvantages of the traditional fibula skin paddle.