Tunneling technique for expedited fibula free tissue harvest

Free fibula transfer can be associated with a slow and tedious dissection/harvest due to difficulty in visualizing the deeper structures. The purpose of this article is to review the first author's (Y.D.) experience with a novel technique for expedited harvest of fibula free flaps for mandibular reconstruction. A retrospective chart review was performed using the first author's clinical practice using chart data from September 1997 to August of 2007. All patients with available chart data who had undergone free fibular transfer for oromandibular reconstruction were included in this study. Charts that met the specified inclusion criteria were reviewed for patient demographic information, reason for free tissue transfer, flap loss rates (partial and total) and reasons for flap loss, average fibula harvest time (tourniquet time), and foot and ankle function postoperatively. During this time, a total of 283 fibula free flaps were performed in 276 patients. The average fibula harvest time (tourniquet time) for all cases was 22.6 minutes, with a range of 14 to 29 minutes. A total of 13 flaps were unsuccessful (failure rate of 4.6%, with 5 total and 8 partial flap losses). This newly described technique will allow for expedited and simplified harvest of fibula free flaps.