Free Fibula Osteocutaneous Flap: Advanced Techniques for Soft Tissue Defect Reconstruction

This book chapter presents a case report and discussion on the use of the free fibula Osteocutaneous flap for the reconstruction of a posttraumatic soft tissue defect with a GIIIB fracture of the tibia and a 6 cm bone defect in the middle third of the left leg. The chapter provides a detailed case presentation, operative procedure, and an extensive discussion on the surgical technique, advantages, and limitations associated with the free fibula Osteocutaneous flap.

The case presentation describes a patient who suffered soft tissue loss and a fracture of both bones in the left leg due to a road traffic accident. Clinical examination revealed a soft tissue defect with a GIIIB fracture of the tibia and a 6 cm bone defect in the middle third of the leg, with an extensor fixator in situ. The surgical intervention involved reconstruction using a free fibula Osteocutaneous flap. The wound was debrided, the dimensions of the soft tissue and bone defects were measured, and the flap was planned and marked on the contralateral leg. The flap was raised, transferred to the defect, and reconstruction was achieved after microvascular anastomosis. The donor site was grafted with split-thickness skin grafts. The postoperative period was uneventful, and satisfactory results were observed during follow-up examinations.

The discussion section introduces the free fibula Osteocutaneous flap as a complex surgical technique used to reconstruct large or composite defects in various anatomical regions, commonly in the head and neck, jaw, and extremities. The surgical technique is described in detail, including patient evaluation and planning, preoperative imaging and vascular planning, flap harvesting, preparing the recipient site, microvascular anastomosis, and flap fixation and soft tissue reconstruction.

The advantages of the free fibula Osteocutaneous flap, such as adequate tissue volume and versatility, vascularized bone transfer, potential for dental rehabilitation, and potential for long-term stability and function, are discussed. The limitations, including surgical complexity and donor site morbidity, are also addressed.

In conclusion, this book chapter provides valuable insights into the use of the free fibula Osteocutaneous flap for the reconstruction of posttraumatic soft tissue defects with associated bone defects. Through a case report, operative details, and an extensive discussion, the chapter highlights the efficacy, considerations, and potential limitations associated with this surgical technique. This information can guide surgeons in making informed decisions and achieving successful outcomes in the reconstruction of complex defects using the free fibula Osteocutaneous flap.