Use of Flow-Through Fibula Flaps in Head and Neck Reconstruction: A Systematic Review

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Background: The application of the flow-through free fibula flap (FTFFF) in head and neck reconstruction is understudied. This systematic review evaluates indications, techniques, and outcomes of FTFFF. Methods: A systematic review of the literature reviewing FTFFF in head and neck reconstruction was conducted. Patient demographics, defect characteristics, surgical indications and techniques, and postoperative outcomes were collected. Results: 19 patients across 10 studies were included. Median patient age was 47 years (IQR 24.5 – 55.0); 36.8% were male, 31.6% female, 31.6% not specified. Median follow-up time was 9 months (IQR 6.0-17.0). 14 patients (73.7 %) underwent mandible-only reconstruction, 3 (15.8%) maxilla-only reconstruction, and 2 (10.5 %) combined maxillomandibular reconstruction. Etiologies included oncologic (n=16), trauma (n=2), and congenital (n = 1). 15.7% (n=3) underwent preoperative radiotherapy. FTFFF was indicated for defect requiring multiple flaps (n=9), lack of skin perforators during harvest (n=6), lack of recipient vessels (n=4), and TMJ reconstruction (n=3). Recipient arteries included facial (n=10), external carotid (n=5), and superior thyroid (n=3); recipient veins included facial (n=8), internal (n=2) or external jugular (n=2), and retromandibular (n= 1). All flaps survived at 6 months. Complications occurred in 31.5% (n=6); hematoma (n=2), venous occlusion (n=2), and wound dehiscence (n=2). Four patients required immediate reoperation. 15.8% (n=3) underwent planned revisions. Preoperative radiation was not significantly associated with postoperative complications (OR 7.20, 95% CI 0.48–108.0; p = 0.236). Logistic regression demonstrated that increasing defect size did not increase complication risk. Conclusions: The FTFFF can be reliably used to reconstruct complex head and neck defects.