Vacularised Free Fibular Flaps (FFF) in Head and Neck Reconstruction

van Zyl, Ottie; Fagan, Johan

Vacularised Free Fibular Flaps (FFF) in Head and Neck Reconstruction

Open Education Resource

2025-10-31

Abstract

The vascularised free fibular flap (FFF) is the most used flap in head and neck for bony reconstruction. It is a vascularised free composite flap containing bone and muscle, with or without skin and provides reliable single-stage reconstruction with excellent functional and aesthetic results. Other vascularised bone flaps used in the head and neck include iliac crest, scapula and radial forearm flaps. Microvascular free tissue transfer allows one to transfer well-vascularised, bone-containing flaps for oromandibular and midface reconstruction. Compared to bone grafts or metal plates, well-vascularised bone is associated with a major reduction of surgical complications and has had an enormous impact on the success of such reconstructions. Vascularised flaps with-stand irradiation much better than bone grafts or plates, and when reconstructing within a previous irradiated field, has the benefit of importing tissue with a new blood supply.