Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

Cohort studyLaryngoscope investigative otolaryngology· Aug 2026

Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

Erich A Mildner, J Benjamin Gordon, Kyle S Hrabovsky … Allison A Slijepcevic

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Microsurgery & FlapsCohort studyTreatmentQ1IF 1.9

Osteocutaneous radial forearm flaps took significantly less operative time than fibula flaps.

Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

Erich A Mildner … Allison A Slijepcevic

Laryngoscope investigative otolaryngology · Aug 2026 · Q1 in Surgery

Background

Fibula free flaps and osteocutaneous radial forearm flaps (OCRFFFs) may be used to reconstruct complex head and neck defects following cancer ablation and trauma.

Purpose

This study aimed to compare the reconstructive outcomes of defects rehabilitated with fibula or OCRFFFs.

Methods

Retrospective chart review completed over 20 years of adult patients greater than 18 years of age undergoing reconstruction of head and neck defects with fibula or OCRFFFs.

n = 52

Results

OCRFFF cut operative time well below fibula flap, with similar survival and complications

697min

Fibula

576min

OCRFFF

More results

Reconstruction type: 26/52 (50%) fibula, 26/52 (50%) OCRFFF.

Charlson Comorbidity Index: 4.6 fibula, 4.7 OCRFFF ( p = 0.43).

Survival rates of both fibula and OCRFFFs: 23/26 (88%) survived, 2/26 (8%) total loss, 1/26 (4%) partial flap loss ( p > 0.99).

More results

Post-operative infection rate: 7/26 (27%) fibula, 7/26 (27%) OCRFFF ( p > 0.99).

“

Conclusion · 1 of 2

OCRFFFs provide reconstruction of composite defects with significantly shorter operative times compared to fibula flaps. Post-operative flap survival and complication rates were similar in both fibula and OCRFFF reconstructions.

Conclusion · 2 of 2

Although OCRFFFs may not undergo dental implantation as the bone stock is thin, the flap may optimally reconstruct composite defects in patients unable to undergo prolonged procedures. LEVEL OF EVIDENCE: 3.

Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

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