Chimeric free fibula lateral supramalleolar flap in selected cases of mandible & maxilla defects- A pilot study

Background: Reconstruction of complex three-dimensional defects following composite mandibular resections is a challenge. Dual skin paddle fibula flap, double free flap, chimeric scapula flap, iliac flaps have been described for reconstruction of these defects. The combination of supramalleolar flap along with fibula flap in a chimeric fashion was less explored and its feasibility to use when harvested from an ipsilateral leg was never studied. We aimed to assess this feasibility. Material & methods: Chimeric free fibula lateral supramalleolar flap (CFSMF) harvest was attempted in 15 patients by the first three authors. The study was conducted between November 2020 and May 2021 (6 months). The study feasibility was analyzed based on defined criteria. Result: The flap could be harvested successfully in 12 patients. The mean age of the study population was 47.5 years (range: 25-59 years). There were 12 male and 3 female patients. The mean distance of the skin perforator from the lateral malleolus was 6.2 cm (range 48 cm). All the chimeric flap components survived except two lateral supramalleolar artery perforator flaps (SMF). There were no other complications. None of the patients had donor site complications. All flaps could be successfully used for the intended purpose. Conclusion: Utilization of CFSMF in day-to-day practice is feasible with certain modifications. It a good choice for the reconstruction of selected composite mandibular defects. The flap combination has several innovative applications as described, a study with a larger sample size would show wider perspectives on this chimeric flap.