Periosteal-Preserving Fibula Onlay Graft With Fibula Free Flap for Vertical Augmentation in Mandibular Reconstruction.

Authors

Ho H Lee, Jia Y Lee, Hyun Il Kang, Young C Kim, Woo S Jeong, Tae H Kim, Jong W Choi

Published in

Annals of plastic surgery. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

To evaluate the clinical outcomes of double-strut fibula onlay bone graft combined with a vascularized fibula free flap for mandibular reconstruction, focusing on long-term graft volume changes and viability.
This retrospective review included 9 patients (7 males, 2 females) who underwent simultaneous reconstruction with a fibula free flap and fibula onlay bone graft between 2017 and 2023. The mean follow-up period was 2.19±1.69 years. Clinical and radiologic data were collected to assess bone volume, speech, dietary function, and postoperative complications. Volumetric analysis was conducted using 3D imaging, and the Mann-Whitney U test was used to compare bone volume changes between the graft and flap groups.
The mean fibula onlay graft length was 5.9±1.7 cm (range: 2.8 to 7.6 cm). Postoperative imaging showed higher bone volumes in the fibula flap group at all time points. The onlay graft group exhibited a higher median percentage bone volume reduction (43.48%) compared with the fibula flap group (22.37%), although this difference did not reach statistical significance (P=0.136), and the series was too small to exclude a clinically meaningful difference. Bone union was achieved in 88.9% of cases, with 1 graft failure (11.1%) and 1 wound infection (11.1%).
In this small, uncontrolled series, the combination of a periosteal-preserving fibula onlay bone graft with a vascularized fibula free flap was feasible and achieved vertical augmentation with acceptable graft viability and a low complication rate. Larger controlled studies are required before the technique can be recommended over established alternatives.

PMID:
42640949
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.