Fundamentals of Vascularized Fibular Free Flap

Free fibula transfer is a microvascular surgical technique that involves the transplantation of a segment of the fibula bone, along with its overlying skin and soft tissue. It was first described by Taylor et al. in 1975 for long bone reconstruction (Chang et al. Plast Reconstr Surg. 102(3):680–688, 1998). Since then, the free fibula flap has become a valuable tool in reconstructive surgery, particularly for complex limb salvage cases, mandibular and maxillary reconstruction, and spinal fusion. The free fibula flap offers several advantages over other techniques, including its versatility, strength, early ambulation, and functional recovery. However, it also presents challenges, such as the need for meticulous surgical planning, specialized expertise, and management of donor site morbidity. This chapter provides a comprehensive overview of free fibula transfers, covering their planning, surgical techniques, complications, and outcomes, with an emphasis on current best practices and future directions.