Early outcomes of osteofascial versus osteocutaneous fibula free flap mandibular reconstruction

Shahaf Shilo*, Nidal Muhanna, Dan M. Fliss, Gilad Horowitz, Anton Warshavsky, Jobran Mansour, Clariel Ianculovici, Ehud Fliss, Yoav Barnea, Arik Zaretski, Ravit Yanko

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: This study compares early outcomes of osteofascial fibula free flap (OF-FFF) with donor-site primary closure and osteocutaneous (OC) FFF with donor-site skin grafting in segmental mandibular reconstruction. Methods: A retrospective chart review of FFF mandibular reconstruction patients (2006–2022) divided into OF-FFF and OC-FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed. Results: The study included 67 patients (39 OF-FFF, 28 OC-FFF). OF-FFF had significantly lower donor-site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC-FFF. Recipient-site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable. Conclusions: OF-FFF mandibular reconstruction with donor-site primary closure is a safe and reliable technique associated with superior donor-site and comparable flap and recipient-site outcomes to OC-FFF, thus may be considered as a viable alternative to OC-FFF for selected patients.

Original languageEnglish
JournalHead and Neck
StateAccepted/In press - 2024


  • donor-site
  • fibula free flap
  • mandibular reconstruction
  • microvascular
  • osteofascial


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