The fibula osteocutaneous free flap now has a recognized place in the therapeutic arsenal of microsurgical mandibular reconstructions. Based on a review of the literature and their own experience, the authors propose a preoperative and intraoperative strategy adapted to reconstructions of mandibular defects. The place of complementary investigations, the site of the skin flap, the choice of osteotomy, the type of fixation, and spatialisation of the skin flap are presented. They conclude on the excellent plastic and vascular qualities of the fibula flap in complex mandibular reconstructions.

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