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Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review
Erich A Mildner1, J Benjamin Gordon1, Kyle S Hrabovsky1
1Department of Otolaryngology Wake Forest University School of Medicine Winston-Salem North Carolina USA.
Laryngoscope Investigative Otolaryngology
|August 6, 2026
Summary
Osteocutaneous radial forearm flaps (OCRFFFs) offer shorter surgical times for head and neck reconstruction compared to fibula flaps. Both flap types demonstrate similar survival and complication rates in complex defect repair.
Area of Science:
- Head and Neck Surgery
- Reconstructive Surgery
- Oncology
Background:
- Complex head and neck defects often require reconstructive surgery after cancer ablation or trauma.
- Fibula free flaps and osteocutaneous radial forearm flaps (OCRFFFs) are common reconstructive options.
Purpose of the Study:
- To compare the reconstructive outcomes of fibula free flaps versus OCRFFFs for head and neck defects.
- To evaluate flap survival, complication rates, and operative times.
Main Methods:
- Retrospective chart review of adult patients (over 18) undergoing head and neck reconstruction.
- Analysis of 52 cases over 20 years, comparing fibula flaps (n=26) and OCRFFFs (n=26).
Main Results:
- OCRFFFs had significantly shorter mean surgical times (576 min) compared to fibula flaps (697 min).
- No significant differences were observed in flap survival rates (88% survival for both), post-operative complications (38% fibula vs. 35% OCRFFF), or infection rates (27% for both).
- Length of stay showed no significant difference between the two flap types.
Conclusions:
- OCRFFFs provide a viable alternative for head and neck reconstruction, offering reduced operative times.
- While OCRFFFs may have limitations for dental implantation due to thin bone stock, they are suitable for patients who cannot tolerate prolonged procedures.
- Both fibula and OCRFFFs demonstrate comparable safety and efficacy in terms of flap survival and complication rates.
