title: Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: a prudent alternative to double flaps in resource-constrained centres.
abstract: OBJECTIVE
  The free fibula flap is the choice flap for mandibular reconstruction following extensive tumor resections. While large defects are managed with a second flap [free or pedicle] in advanced centres, a free fibula flap with a large skin paddle that can be de-epithelised to provide outer skin and inner lining is the best alternative in resource- constrained centres.
  
  
  METHODS
  From January 2005 to December 2009 a total of 386 free fibula flaps were used of which 307 flaps had de-epithelised double skin paddle in reconstructing complex oral and mandibular defects after tumor ablative surgeries.
  
  
  RESULTS
  Complete flap survival was seen in 282/307 patients. Complete flap loss was seen in 9/307 patients. Partial flap loss was seen in 16 patients. Re - exploration was done in 30 patients and the flap was salvaged in 21 patients.
  
  
  CONCLUSIONS
  The vascular supply of the free fibula osteo myocutaneous flap is reliable and a flap with a large skin paddle can be used to provide both inner lining and outer cover in resource-constrained centres.
authors.affiliation: Plastic and Reconstructive Services, TATA Memorial Hospital, Mumbai, India.
authors.forename: Prabha S
authors.initials: PS
authors.lastname: Yadav
authors.forename: Quazi G
authors.initials: QG
authors.lastname: Ahmad
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Shankhdhar
authors.forename: G I
authors.initials: GI
authors.lastname: Nambi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002648:Child; D005260:Female; D005360:Fibula / Q000601:surgery*; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D055815:Young Adult