Fibular Flap

Abstract

The first microvascular bone transfer was performed by Taylor and coworkers, who used a vascularized myo-osseous segment of the fibula for treatment of a post-traumatic defect of the tibia in 1975 [382]. Since this first description, the primary indications for the fibular bone flap have been reconstructions of extended bone defects in the extremities using a posterior approach for flap harvesting, which was originally described by Taylor et al. [382]. Whereas these first transfers of the fibula were performed without including a skin paddle, Chen and Yan were the first to report an osteocutaneous fibula flap in 1983 [64]. This extension of flap raising became possible following the proposal of Gilbert to use a lateral approach for harvesting the bone flap, which was easier to perform and allowed for visualization of the cutaneous branches of the peroneal artery [120]. A valuable extension of the indicational spectrum of the fibular flap was achieved by the report of Hidalgo, who performed the first lower jaw reconstruction using osteotomies to mimic the shape of a nearly entire mandible in 1989 [152]. Since that time, the fibula flap has proven to be a valuable method for mandible reconstruction, especially in extended defects, exceeding the length of half a mandible [64, 110, 152, 227, 334, 349, 416, 431].