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imageBackground: The osteoseptocutaneous fibula flap has been widely used for bone and soft tissue reconstruction from its first description in 1975. Nowadays, this flap has become the workhorse flap for head and neck reconstruction because of its suitability for mandible reconstruction. However, the reliability of the skin paddle is still controversial. We described a modified method for the harvesting of an osteoseptocutaneous flap to obtain a more reliable skin paddle while minimizing the donor site morbidity.
Methods: One hundred fifty-one consecutive patients were enrolled in the current study from January 2005 to December 2013. All of them underwent a free osteoseptocutaneous flaps for either head and neck (n = 135) or extremity (n = 16) reconstruction following the posterior approach harvest technique. Demographics data of all the patients were collected: age, sex, defect location, and etiology. The variables included for the statistical analysis were: size of the skin paddle, time of harvesting, reoperation, split skin paddle, and single or double barrel fashion for the inset. The outcomes measured were the flap success rate and the skin paddle survival.
Results: The flap success rate was 97.3%. The mean harvesting time was 45 minutes. The mean width and length of the skin paddle was 7.1 ± 2.6 and 17.41 ± 4.4 cm, respectively. The reexploration rate was 18.5%, and the salvage was achieved 85.7% of the cases. Partial skin paddle necrosis was found in 13.2% of the cases. The fact of having a reexploration in the postoperative period was the only variable significantly associated with the skin paddle necrosis (P = .001).
Conclusions: According to our experience, the posterior approach for the harvest of the osteoseptocutaneous fibula flap is a safe technique and offers many advantages, such as a better visualization of the perforators, beneficial for chimeric flap elevation, preservation of the muscular fascia in the donor site, and an earlier diagnosis of any anatomical variation. Both the reliable and the versatility of the skin paddle can substantially improve with this approach.

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