Bilobed skin paddle fibula flap for large oromandibular defects

Although the fibula free flap (FFF) is a useful choice for mandible reconstruction, its application for large oromandibular defects is still debated upon. We report the use of FFF with a bilobed perforator-based skin paddle for combined hemiglossectomy, floor-of-the-mouth, tonsillar pillar, and mandibular body defect. A case of an 84-year-old woman with a 2.5 × 3.5-cm exophytic ulcerated mass on the right side of the tongue, extended to omolateral gengival fornix, tonsillar pillar, and mandibular body, is reported. An osteocutaneus FFF with a 7-cm bone strut and a 17 × 10-cm bilobed shaped skin paddle was performed. The longer lobe was used to restore tongue shape, whereas the smaller lobe was used to line the pelvic floor, gingival, and tonsillar pillar. The postoperative period was uneventful. The patient was capable to protrude her neotongue beyond the virtual incisors line and to touch the hard palate at different degrees of mouth opening. The bilobed perforator-based skin paddle FFF is felt to be a sound option for large compound oromandibular defects offering the possibility to safely base the skin component on a single peroneal perforator while achieving effective tongue mobility preservation.