Triple Skin Island Fibula Free Flap: A Good Choice for Combined Mandible and Tongue Defect Reconstruction

ABSTRACT

Resections of malignant tumors involving the mandible and anterior tongue result in complex defects that are still real challenges for reconstructive surgeons. Whereas there are preferred methods for mandible reconstruction involving isolated or limited loss of soft tissues, there are no standards for extended bone–soft tissue intraoral defects. This article documents the modification of the fibula free flap where triple skin islands are used for reconstruction of anterior tongue and floor of the mouth. The technique also includes filing the submandibular space with an isolated part of the flexor hallucis longus muscle, based on individual perforator. The details of flap designing, harvesting, and insetting are also presented. Eight such reconstructions have been performed on patients who underwent complex resection of the anterior mandible together with the mobile part of the tongue. Flap survival rate was 100%. In all eight cases, understandable speech and return to unrestricted diet mastication and swallowing were achieved. Analysis of aesthetic effects showed generally very good results. The presented modification of fibula free flap can be an alternative to double flaps in complex reconstruction of the mandible and mobile tongue.

Triple skin island fibula free flap - flexor hallucis longus muscle - quality of life

REFERENCES

• 1 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg. 1989;  84 71-80
• 2 Haughey B H. Tongue reconstruction: concepts and practice.  Laryngoscope. 1993;  103 1132-1141
• 3 Schusterman M A, Reece G P, Miller M J, Harris S. The osteocutaneous free fibula flap: is the skin paddle reliable.  Plast Reconstr Surg. 1992;  90 787-793
• 4 Hidalgo D A, Rekow A. A review of 60 consecutive fibula free flap mandible reconstruction.  Plast Reconstr Surg. 1995;  96 585-596
• 5 Sultan M R, Coleman III J J. Oncologic and functional considerations of total glossectomy.  Am J Surg. 1989;  158 297-302
• 6 Urken M L, Weinberg H, Vickery C et al.. The combined sensate radial forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects.  Laryngoscope. 1992;  102 543-548