Fibula Free Flap Reconstruction

Following removal of oral, head and neck pathology (e.g., cyst, tumor), patients need to re-establish or improve their function and appearance. They can turn to oral and maxillofacial surgeons (OMSs) who have completed advanced training in a reconstruction process involving microvascular surgery that requires moving one part of the body to another using its own blood supply.

Free flap reconstructive surgery is one of the procedures performed by an OMS to help patients who have had resection of an oral pathology requiring bone reconstruction. “Free flap” means the tissue is completely relocated from one part of the body to another, including the blood supply. The surgery – performed when patients need their jaw or parts of their face reconstructed – involves bone and soft tissue from different parts of the body. While this donor tissue can come from multiple locations in a patient’s body, mandibular (lower jaw) reconstruction is often performed with a fibula free flap procedure. The fibula free flap takes bone, muscle, skin and blood vessels from the patient’s lower leg and uses that to rebuild the structures of the face/jaws.

What Does Fibula Free Flap Surgery Involve?

During surgery, the OMS will:

• Remove the cancer/tumor/pathology from the jaw and soft tissue surrounding it.
• Remove bone/skin/muscle as needed along with a connected vein and artery from the patient’s leg.
• Shape the bone from the donor site to match the removed portion of the jaw.
• Connect the artery and vein from the donor to the head and neck.
• Secure the new jawbone with plates and screws as well as cover the area with soft tissue.
• Suture the face and neck to connect the soft tissue.

Advantages of the Fibula Free Flap

There are unique advantages to using the fibula for reconstructive surgery, including:

• A large length of bone is available.
• Bone can be contoured to match the jaw.
• The ease of obtaining from the donor site with few side effects for the patient.
• Dental implants can be placed into this bone, sometimes during the same surgery when the free flap is harvested and used for reconstruction.

While the patient’s leg will be bandaged following surgery, the removal of the fibula usually has minimal impact on walking. Many patients are able to resume light walking within a week and climbing stairs within two weeks. It can be necessary to remove skin in addition to the fibula. (If the surgeons do remove skin from the leg, it may be replaced with a skin graft.)

Learn More about Treatment for Oral, Head and Neck Pathologies

People experiencing symptoms of oral, head and neck pathology – including difficulty swallowing or abnormal lumps around the neck or jaw – should contact an OMS for a consultation. After a diagnosis, the fibula free flap and other options may be discussed.