Midface reconstruction with the fibula free flap

OBJECTIVE: To evaluate the use, indications, and outcomes of the fibula osteocutaneous free flap when reconstructing the midface. DESIGN: Retrospective review of a case series. SETTING: Tertiary referral center. PATIENTS: We evaluated all patients requiring midface reconstruction after tumor resection between January 1, 1994, and January 1, 2000. Twenty-seven individuals who lacked sufficient retentive surfaces and/or teeth to support a conventional prosthesis were offered vascularized bony reconstruction. INTERVENTIONS: All patients underwent fibular osteocutaneous free flap reconstruction of the midface: 16 primarily, 11 secondarily. MAIN OUTCOME MEASURES: Success of free tissue transfer, perioperative complications, oral diet, speech, type of dental reconstruction, and cosmesis. RESULTS: Twenty-six of 27 flaps survived. Four patients had wound complications managed successfully with local wound care. Fourteen patients achieved a regular diet and 13 patients maintain a soft diet. Eighteen patients had osseointegrated implants placed, and 14 patients used an implant-borne prosthesis. Cosmetic results were judged to be excellent in 14 patients; good in 8; fair in 4; and poor in 1. CONCLUSIONS: Use of the fibula osteocutaneous free flap to reconstruct the midface is highly reliable and our flap of choice for lower maxillary defects requiring bony reconstruction. However, when orbitozygomatic support is the primary objective, the utility of this flap is limited. Because of the complexity of this procedure, the choice of midface reconstruction technique should be individualized for each patient.