Practical Tips for Harvesting Microvascular Fibula Flap

First described by Hidalgo in 1989 for use in the head and neck, the fibula osteomyocutaneous free flap hsa become a workhorse reconstructive option for composite maxillofacial defects. Following improvements in the understanding of pertinent surgical anatomy, surgeons can expect predictable outcomes with multiple bony segments and the use of a corresponding skin paddle. The distant nature of the fibula facilitates a two-team approach, which yields a shorter operating time for both the patient and surgical team. Donor site morbidity is generally mild and does not preclude patients from resuming an active lifestyle following recovery. Recent advances in computer-assisted surgical planning have paved the way for guided “jaw-in-a-day” modalities, which provide the most complete immediate restoration of function. The purpose of this chapter is to review pearls and pitfalls for harvesting microvascular fibula flap.