Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures.

OBJECTIVES/HYPOTHESIS The purpose of this study was to analyze our experience with the composed double skin paddle fibula free flap to reconstruct large mandibulofacial defects. STUDY DESIGN Between 2006 and 2011, a total of 32 composed double skin paddle fibula free flap procedures were performed on 32 patients (mean age 54.4 ± 9.7 years, mean follow-up period of 3.4 ± 1.7 years). METHODS A chart review was drawn up to determine the type of defects covered by each skin paddle, the vascular anatomy, the origin of the perforators, and any associated complications. RESULTS The distal septocutaneous skin paddle (Nakajima type B) was used for the reconstruction of the floor of the mouth in most cases. The proximal paddle (Nakajima type D) was used for base of the tongue, mobile tongue, soft palate, internal cheek, inferior lip, and the skin of the chin and neck. The lateral soleus pedicle arose from the fibular pedicle in 28 cases and directly from the tibial-fibular trunk in four cases. There were two partial soleus skin paddle losses. Seven complications required revision surgery: due to a cervical abscess in two cases, due to a hematoma in two cases, due to a disunion of the second skin paddle leading to an orostoma in two cases, and due to an exposition of the osteosynthesis material in one case. CONCLUSION In large mandibulofacial defects, a second skin paddle raised on the soleus perforators may be of benefit when reconstructing the soft palate, neck, cheek, or tongue as the length of its pedicle renders a second free flap unnecessary. LEVEL OF EVIDENCE IV.