title: The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations.
abstract: BACKGROUND
  The aim of this study was to investigate the intraoperative findings, postoperative complications, donor site morbidity and patients' Quality of Life in order to evaluate the usefulness of the free osteofasciocutaneous fibula flap in the reconstruction or construction of a mandibula, neophallus, lower leg or forearm.
  
  
  METHODS
  104 patients were treated with free osteofasciocutaneous fibula flaps in our clinic. 23 for mandible reconstruction, 66 for neophallus reconstruction, 9 for lower leg reconstruction and 6 for forearm reconstruction. These patients were asked to answer a questionnaire and to be present for a clinical and a radiological examination in our department. In addition, their previous records were evaluated retrospectively.
  
  
  RESULTS
  The dimension of the surface of the skin island was 178.6 cm(2) (72-352 cm(2)) in average and the average length of the fibular bony part was 15.4 cm (10-23 cm). The most frequent and severe complication was skin island edge necrosis (n=7); no total flap necrosis was found. Donor-site morbidity was low, since no joint instability could be reported. Quality of Life was improved according to the standardised FLZ(M) questionnaire.
  
  
  CONCLUSIONS
  Advantages of free osteofasciocutaneous fibula flaps were the wide cortical bone and the relative constant anatomy, the long pedicle, flat, uniform and sufficient large and pliable skin island, as well as the good blood circulation also by massive modelling of the skin and bone part. The skin island could be harvested large enough in order to reconstruct extended soft-tissue defects in the face and the extremities as well as to construct neophallus in its normal size without any restrictions. The lower leg donor-site morbidity was moderate and can be readily covered with a sock in patients' everyday life common activities. Finally, in our hands, the utilisation of the free osteofasciocutaneous fibula flap is the best possible therapy for these difficult composite reconstructions.
authors: Department of Plastic Surgery & Hand Surgery, Munich Technical University, Ismaningerstr. 22, D-81675 Munich, Germany.
authors: Hanno
authors: H
authors: Pototschnig
authors: Clinic for Plastic and Aesthetic Surgery, Munich, Germany.
authors: Juergen
authors: J
authors: Schaff
authors: Department of Plastic Surgery & Hand Surgery, Munich Technical University, Ismaningerstr. 22, D-81675 Munich, Germany.
authors: Laszlo
authors: L
authors: Kovacs
authors: Department of Plastic Surgery & Hand Surgery, Munich Technical University, Ismaningerstr. 22, D-81675 Munich, Germany.
authors: Edgar
authors: E
authors: Biemer
authors: Department of Plastic Surgery & Hand Surgery, Munich Technical University, Ismaningerstr. 22, D-81675 Munich, Germany. Electronic address: n.papadopulos@lrz.tum.de.
authors: Nikolaos A
authors: NA
authors: Papadopulos
mesh_terms: D016025:Bone Transplantation / Q000009:adverse effects; D005205:Fascia / Q000098:blood supply*; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation; D005542:Forearm / Q000294:innervation / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008334:Mandible / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D010413:Penis / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D011795:Surveys and Questionnaires; D016896:Treatment Outcome