The "Origami" Composite Free Fibula Flap for Complex Defects of the Mandible, Floor of the Mouth, and Tongue.
OBJECTIVE
The fibula flap serves as the workhorse for many mandibular defect types. For massive defects that include the mandible, floor of the mouth, and tongue, reconstruction might mandate a 2-flap approach. This report describes a systematic yet flexible design of a single composite osseocutaneous fibula flap for such cases.


METHODS
From 2003 through 2011, 5 patients underwent surgery for T4 squamous cell carcinoma and adenoid cystic carcinoma. They underwent wide resection of the mandible and floor of the mouth with hemi- to subtotal glossectomy. A large skin paddle was designed on the leg using a customized template consisting of 3 components matching the alveolar, floor-of-mouth, and tongue segments. The round tongue component was folded using its thickness to provide 3-dimensional volume and form in place of the missing tongue. The other 2 components had a crescent shape and were adjusted intraoperatively to match the resected defect.


RESULTS
All 5 flaps survived, with 1 case of flap loss that was successfully replaced. Delayed healing of the leg donor site was encountered in 4 patients.


CONCLUSIONS
The proposed single 3-dimensionally folded flap design provides ample tissue to replace bony and soft tissue elements for major anterior or lateral segment defects. There was morbidity owing to donor-site complications but these were treatable, with recorded functional restoration.
Consultant, Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address: amirinbal@hotmail.com.
Amir
A
Inbal
Department Head, Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Eyal
E
Gur
Unit Head, Microsurgery Service Unit, Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Arik
A
Zaretski
Unit Head, Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Yoav
Y
Barnea
Department Head, ARAM Center of Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel.
Avi
A
Khafif
Service Head, Head and Neck Reconstructive Service, Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Aharon
A
Amir
D000328:Adult; D016025:Bone Transplantation; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005360:Fibula; D006801:Humans; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014059:Tongue / Q000601:surgery