Mandible Reconstruction With Double-barrel Second-story Fibula Osteocutaneous Flap

In this study, we report a novel reconstructive procedure for mandibular defects following resection. From 2021 to 2025, a single fibular osteocutaneous flap, folded in half while preserving its blood supply, was performed in 7 patients. The inclusion criteria for the study required a preoperative computed tomography scan demonstrating a 2-fold difference between the heights of the mandible and fibula. Among the participants, 5 were men and 2 were women, aged 40-67 years (mean age: 57.9 y) at the time of surgery. The original diagnoses included 1 case of ameloblastoma and 6 cases of mandibular gingival cancer. The mean length of the bone defect was 6.4 cm (range: 6-7 cm). In 5 of the 7 cases, the defect was classified as a straight defect. In the remaining 2 cases, the bone exhibited a single fold at the transition between the anterior and lateral portions of the mandible. In 3 of the 4 cases evaluated more than 2 years after reconstructive surgery, it was possible to place implants in the grafted bone of the folded area. This approach, which uses a single fibular osteocutaneous flap folded in half while maintaining its blood supply, seems to be an effective reconstructive method, achieving excellent cosmetic and functional outcomes in patients with bone defects.