Double skin paddle fibular flap for a through-and-through oromandibular defect

The fibular osteocutaneous free flap has become the most versatile method for reconstructing composite defects of the mandible. The complexity of the reconstruction increases substantially when both intraoral and extraoral defects are present, possibly dictating the need for an additional flap. For the smaller through-and-through defects, a single skin island may be sufficient, but may be limited by inadequate reach. Although not routinely necessary, the skin island may be split completely to enhance the effective reach of the second paddle. One patient report is presented for which a moderately sized through-and-through defect of the mandible was reconstructed using a double skin paddle fibular osteocutaneous free flap.