The Surgeon's Fist with the Thumb Up to Guide the Design and Inset of the Osteoseptocutaneous Fibula Flap in Mandibular Reconstruction

Successful reconstruction of an oromandibular defect with the osteoseptocutaneous fibula flap necessitates flawless design and inset, which is an experience-demanding endeavor. Laterality of the fibula flap has been thought to pose a certain challenge to reconstruction. To address this concern and guide flap design and inset, the authors proposed using the surgeon's fist with the thumb up to replicate key anatomical landmarks of the fibula flap: the peroneal vessels and proximal bone end, and the posterior crural septum including the septal vessels, the skin, and the lateral surface of the fibula bone. This method facilities recipient vessels selection and skin paddle design, orientation, and inset to avoid complications regardless of laterality.