Chimeric LSMAP Double-barrel Fibula Free Flap: Goal-oriented Surgical Technique and Tips for One-stage Mandibular Reconstruction

Composite oromandibular defects involving jaw bones, intraoral and skin/soft tissues, or dynamic structures such as the tongue, soft palate, and pharynx are real reconstructive challenges even today. Despite improvements in oral dental rehabilitation, another complex task to deal with in young patients with dentate or nonatrophic mandible is correcting a too large vertical occlusal dimension, which makes the prosthodontic rehabilitation very challenging. Instead of using more complex and time-consuming methods such as simultaneous free flaps and to avoid further bone graft and second-stage revision procedures, an innovative double-barrel shaped chimeric fibula free flap with lateral supramalleolar artery perforator flap is used to fulfill all of the reconstructive requisites in one-stage. This new operative technique has never been described before. To deal with a complex head and neck reconstruction, the step-by-step harvesting technique, flap design, and inset of flap are described, giving tips and tricks to avoid jeopardizing its vascularity. A proper match between the bone transplant and native mandible, together with a sufficient amount of tissue for proper oropharyngeal reconstruction was achieved in one stage. Both the functional and aesthetic results were excellent, requiring no further revisions in a second stage. The chimeric fibula free flap with lateral supramalleolar artery perforator flap is a novel, versatile, and useful technique that provides a good opportunity for clinicians and patients to achieve adequate prosthetic rehabilitation and improved aesthetics in reconstruction of postablative extensive oromandibular defects in one stage.