MANDIBULAR RECONSTRUCTION WITH A FREE FIBULAR FLAP: A CASE REPORT
DOI:
https://doi.org/10.66104/6t5r3v44Keywords:
Fibula flap; Mandibular reconstruction; Preplates; Free tissue transfer; Mandible.Abstract
Introduction: Mandibular reconstruction represents one of the greatest challenges in reconstructive head and neck surgery, especially in patients with osteoradionecrosis, a condition characterized by tissue hypoxia, hypovascularity, and severe impairment of natural healing mechanisms. The free osteoseptocutaneous fibular flap has become the gold standard in this setting, offering intrinsic vascular supply, adequate bone length, the possibility of multiple osteotomies, and a reliable cutaneous component for simultaneous soft tissue reconstruction. Objective: To report a case of mandibular reconstruction with a free osteoseptocutaneous fibular flap in a young patient with osteoradionecrosis of the right mandibular body and ramus, describing the preoperative planning, the surgical technique employed, and the results obtained during the six-month follow-up period. Case Report: A 34-year-old female patient with a history of squamous cell carcinoma of the floor of the mouth treated with a combined radiotherapy and chemotherapy protocol, total dose of 66 Gy, developed osteoradionecrosis of the body and ramus of the right mandible approximately two years after the end of cancer treatment. After multidisciplinary clinical preparation with control of local infection, nutritional optimization, and targeted antibiotic therapy, the patient underwent resection of the affected mandibular segment and reconstruction in a second stage with a free osteoseptocutaneous fibular flap from the left lower limb. Surgical planning was performed with the aid of a three-dimensional stereolithographic model. The bone segment obtained measured 12 centimeters, with a skin flap of seven by four centimeters, modeled with two wedge osteotomies to reproduce the mandibular contour. Microvascular anastomoses were performed with the facial artery and vein, with a warm ischemia time of 47 minutes. The postoperative period was uneventful, with hospital discharge on the eighteenth day. Six-month follow-up demonstrated satisfactory bone integration, 35 mm mouth opening, functional mastication, preserved phonation, and minimal donor site morbidity. Conclusion: The free osteoseptocutaneous fibular flap proved to be a safe and effective option for mandibular reconstruction in the context of osteoradionecrosis, with satisfactory functional and aesthetic results. The success of the procedure was directly related to careful planning and perioperative multidisciplinary support, reinforcing that the quality of the results of this reconstructive modality depends on the set of decisions adopted at all stages of treatment
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Copyright (c) 2026 Giuseppe Mazzaglia, Emerson Eduardo Toldo, Cristian Duane Pires, Patrícia Beatriz Araújo Gomes, Alexsandro do Nascimento Silva, Pablo Luiz Moraes Teles, Cíntia Moreira Gonçalves, Vitor Rodrigues da Silva, Rayssa Even Matos de Souza, Rickson Pinheiro de Lima, Cindy Bastos de Souza, Pablo Ruan Nogueira Dantas, Iasmin Nacer de Oliveira Machado, João Paulo Rodrigues Torres
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