title: Reconstruction of the through-and-through anterior mandibulectomy defect: indications and limitations of the double-skin paddle fibular free flap.
abstract: OBJECTIVE
  The purpose of this report is to describe our recent experience using a double-skin paddle fibular free flap (DSPFFF) for reconstruction of the through-and-through anterior mandibulectomy defect and to present a reconstructive algorithm based on the extent of lip and mental skin resection.
  
  
  METHODS
  Retrospective review of 10 consecutive patients with through-and-through anterior mandibulectomy defects.
  
  
  METHODS
  Outcomes that were examined included methods of reconstruction based on the cutaneous defect, flap complications, fistula rate, and donor site complications.
  
  
  RESULTS
  Seven patients were reconstructed with a DSPFFF. For lip reconstruction, two patients were also concomitantly reconstructed with Karapandzic or lip advancement flaps. Three patients were reconstructed with both a fibular free flap and a second free flap (1 radial forearm fasciocutaneous flap and 2 anterolateral thigh flaps). The transverse dimensions of the DSPFFFs were as great as 15 cm. None of the patients developed a fistula. All free tissue transfers were successful. One patient developed partial loss of the fibular skin paddle used for submental skin replacement.
  
  
  CONCLUSIONS
  DSPFFF is a safe and reliable way to reconstruct an anterior through-and-through mandibular defect. Indications for using a DSPFFF are 1) a cutaneous defect that lies at or below the plane of the reconstructed mandible, 2) a transverse width of the oral mucosa and cutaneous defect that does not exceed 15 cm (the approximate distance from the mid-calf to the anterior midline), and 3) a lip defect that, if present, can be reconstructed with local flaps.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. deleyiannisfw@msx.upmc.edu
authors.forename: Frederic W-B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rogers
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Lai
authors.forename: Seungwon
authors.initials: S
authors.lastname: Kim
authors.forename: Jonas
authors.initials: J
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D005927:Glossectomy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008046:Lip / Q000601:surgery; D008297:Male; D008334:Mandible / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome