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Free Fibula Osteocutaneous Flap With Soleus Muscle as a Chimeric Flap for Reconstructing Mandibular Segmental Defect After Oral Cancer Ablation

Kuo, Yur-Ren MD, PhD, FACS*; Shih, Hsiang-Shun MD*; Chen, Chien-Chang MD*; Boca, Radovan MD, PhD*; Hsu, Yao-Chung MD; Su, Chih-Ying MD; Jeng, Seng-Feng MD, FACS*; Wei, Fu-Chan MD, FACS*

doi: 10.1097/SAP.0b013e3181a72f62
Hand Surgery and Microsurgery

In some cases, the fibula osteocutaneous flap may not provide sufficient soft tissue for obliterating dead space after tumor ablation. This report describes a modified fibula osteocutaneous flap using a portion of soleus muscle to reduce postoperative complications.

This study analyzed 20 patients who underwent ablative oral cancer surgery with mandibular segmental defect between September 2005 and June 2007. Of total, 17 cases were mandible complex defects and 3 were composite defects. Of total, 18 were men and 2 were women, respectively. Age range was 30 to74 years, and mean age was 53 years. The procedure entailed harvest of chimeric fibula flap with skin paddle and bone segment composed of a sheet of soleus muscle (7 × 4 to 12 × 5 cm in size) originating from the perforator branch of the peroneal artery. The soleus muscle was used to obliterate the dead space of the mouth floor and cheek-neck area.

All flaps survived except 1 failure due to venous insufficiency. The submandibular and chin area exhibited mild swelling at the submandibular area early postoperatively. Patients had achieved satisfactory contour without donor site morbidity at a mean 12-months of follow-up. Complications included 2 flaps requiring reoperation due to the flap pedicle compromised. One flap was successfully salvaged but the other failed. Two cases of orocutaneous fistula-induced infection recovered after conservative treatment. Donor site assessment revealed a satisfactory outcome without major donor site morbidity.

This refinement in mandibular reconstructive surgery substantially reduces postoperative complications.

From the Departments of *Plastic and Reconstructive Surgery and †Otolaryngology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Received December 25, 2008, and accepted for publication, after revision, March 25, 2009.

Presented at the IV Congress of World Society for Reconstructive Microsurgery (WSRM), June 24–26, 2007, Athens, Greece.

Reprints: Yur-Ren Kuo, MD, PhD, FACS, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, Taiwan. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.