Refinement of the fibular osteocutaneous flap using tissue expansion

The most serious objection to many otherwise advantageous cutaneous donor areas may be the cosmetic deformity from the exposed skin graft that is required for wound closure. Any contemplated fibular osteocutaneous composite tissue transfer that would result in such an obviously large donor defect therefore deserves consideration for pretransfer tissue expansion or simultaneous placement of tissue expanders at the time of flap elevation. Post-transfer expansion of the lateral lower leg donor site following semi-urgent reconstructions has provided significant aesthetic improvement, allowing the transformation of skin-grafted or open areas into a more acceptable linear scar.