The Fibula Free Flap as Used for Reconstruction in Patients With Oral Cavity Malignancy: A Systematic Review
In brief
Fibula flaps failed completely in 5.9% of oral cancer reconstructions
A review of eight studies covering 340 patients found total flap failure in 5.9% and partial failure in 8.5%. Complications were common in the studies that reported them, including at recipient and donor sites, but the evidence was too varied for pooled analysis; how often complications cause lasting disability remains unclear.
- Journal
- World journal of otorhinolaryngology - head and neck surgery (Q1)
- Published
- 29 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Rohan Vuppala, Nicholas Owings, Forest Weir
- PMID
- 42812708
- DOI
- 10.1002/wjo2.70172
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 3 October 2026): Fibula free flap outcomes after oral cavity malignancy
Abstract
OBJECTIVES: The fibula free flap is a widely used means of reconstructing the maxilla and mandible. It is used for a variety of indications, including for reconstruction after resection of a benign or malignant tumor, osteoradionecrosis, or trauma. The current literature reports outcomes for the fibula free flap across all indications, but there is a paucity of information regarding outcomes when the flap is performed exclusively after resection of malignancy. The authors report a systematic review of the literature and report flap survival rates, flap complications, donor site complications, and systemic complications. DATA SOURCES: PubMed, Embase, CINAHL, and Cochrane Library databases. METHODS: Relevant data extracted included study design, number of included patients, type of maxillary or mandibular defect, total and partial flap necrosis, and other flap complications. Study-level synthesis without meta-analysis (SWiM) was performed due to heterogeneity of data across studies. RESULTS: Eight studies (n = 340) met criteria. Total flap failure: 20/340 (5.9%) and partial failure: 29/340 (8.5%). Among studies reporting, secondary recipient-site complications occurred in 104/256 (40.6%), donor-site in 51/166 (30.7%), and systemic in 49/210 (23.3%). Thirty-day mortality was 3/151 (2.0%) and recurrence 67/241 (27.8%). CONCLUSIONS: Our findings affirm the high success rates in flap survival and functional restoration, highlighting the robust vascular supply and adaptable soft tissue options offered by the fibula free flap. Moreover, while the incidence of complications is not negligible, the long-term complications regarding donor site morbidity and limb function are rare.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.