Mandibular reconstruction with free osteocutaneous fibula flap using the occipital artery as recipient vessel

Authors performed reconstructive surgery for extensive skin and mandibular bone defect following gunshot injury to the left side of the face. The soft tissue and bone defect was reconstructed with the free osteocutaneous fibula flap harvested from the left lower leg, as suitable local reconstructive flap was not available. The bony continuity was reestablished with a 7 cm long fibula segment. Microvascular anastomoses were performed to the left occipital artery and the left internal jugular vein. The occipital artery was chosen as the external carotid system was completely missing on the right side and was missing several branches on the left side due to the trauma. The fibular segment became fully incorporated and 95% of the flap healed by primary intention.