Abstract— Free fibular flap is the most favored free flap for composite defects of oro-mandibular region. Composite defects involving mucosa, mandible and skin often require two free flaps for the reconstruction. A technique of harvesting two separate cutaneous paddles of free fibular flap each based on a definite peroneal artery perforator was presented in this study. Reconstruction of composite oro-mandibular defect was done with two independent cutaneous paddles (proximal skin paddle based on musculo-cutaneous perforator and distal skin paddle based on septo-cutaneous perforator) in 12 patients. Post operative outcome was good, with 11 cases having no loss of skin paddle. There was an outer skin paddle necrosis in one patient for which cover was given with pectoralis major myocutanous flap. A double paddle free fibula flap can be used to reconstruct composite defects providing inner lining as well as skin cover with good flap success rates and better functional and aesthetic patient outcomes, thus avoiding an additional free or regional flap morbidity and decreased operative time.
Keywords: Oro-Mandibular Reconstruction, Free Fibula Flap.
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