Nunchaku-like Free Fibula Osteocutaneous Flap in Through-and-through Composite Oromandibular Defect Reconstruction

The free fibula osteocutaneous flap (FFOCF) has been used for oromandibular reconstruction over several decades. However, when facing through-and-through composite oromandibular defects (COMDs), significant challenges still arise. The complexity of COMD necessitates the reconstruction of bone, intraoral mucosa, and extraoral skin. Additional flaps are often needed, which extend surgical durations and heighten associated risks. This report presents a 62-year-old man with squamous cell carcinoma of the left lower gingiva. After ablative surgery, successful reconstruction of a through-and-through COMD was achieved with a single FFOCF through innovative design. The flap was osteotomized into 2 segments with attached skin islands while preserving the vascular pedicle. Rotation of 1 segment created 2 skin islands on opposing sides, simultaneously repairing intraoral and extraoral defects. Postoperative outcomes at the 1-month follow-up were encouraging. Although technically challenging, the "Nunchaku-like FFOCF" offers a safe and effective approach for the comprehensive reconstruction of through-and-through COMD.