Two in one: Double free flap from a single free fibula osteocutaneous unit

Abstract

In the past two decades, the advancement in the microsurgical techniques has revolutionised the reconstruction of post-oncological head and neck defects. Free fibula osteocutaneous flap (FFOCF) has been considered as the treatment of choice by many for mandible reconstruction. The improvement in the surgical resection and adjuvant treatment has improved the survival rates even in patients with advanced cancer. Simultaneously the reconstruction is addressed towards more functional and aesthetic aspects to improve the quality of life in these patients. In this respect, a double free flap is advocated in certain cases of extensive composite oromandibular defects (COMDs). But in our institute, we have managed two such cases of extensive COMD with a single FFOCF unit – fibula bone with a skin paddle for inner lining and a perforator-based skin paddle from the proximal part of the FFOCF unit, anastomosed separately for outer cover. Compared to two separate free flaps, this method has the advantage of single donor site and reduction in reconstruction time. Though the technique of divided paddle, deepithelisation and supercharging has been mentioned for FFOCF, no such clinical cases of two free flaps from a single FFOCF unit have been mentioned in the literature.

Recent advances in head and neck cancer reconstruction

“…[ 15 ] Second flap is advised, when the intraoral, as well as extraoral defects, are very extensive or when these defects are at different separate locations. This second flap can be generated from same fibular flap skin paddle by using proximal perforator[ 16 ] or separate flap from a different donor site. [ 17 ] Sensate FFOCF have been reported.…”