title: A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: experience on a series of 10 cases.
abstract: BACKGROUND
  We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures.
  
  
  METHODS
  Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design.
  
  
  RESULTS
  The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period.
  
  
  CONCLUSIONS
  The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Tyng-Luen
authors.initials: TL
authors.lastname: Roan
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Chen
authors.forename: Yen-Chen
authors.initials: YC
authors.lastname: Yu
authors.forename: Jung-Hsien
authors.initials: JH
authors.lastname: Hsieh
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Horng
authors.forename: Hao-Chih
authors.initials: HC
authors.lastname: Tai
authors.forename: Nai-Chen
authors.initials: NC
authors.lastname: Cheng
authors.forename: Hsiung-Fei
authors.initials: HF
authors.lastname: Chien
authors.forename: Yueh-Bih
authors.initials: YB
authors.lastname: Tang
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D000077195:Squamous Cell Carcinoma of Head and Neck; D020858:Tissue and Organ Harvesting / Q000379:methods*