It has since become the “work horse” of mandibular reconstruction, and is also commonly used for maxillary reconstruction. It was further popularized by Wei and colleagues ( 3), who were able to demonstrate the reliability of this flap consistently in a large patient series. in 1975 ( 1), however Hidalgo ( 2) was the first to use this flap for mandibular reconstruction, however, not until 1989. The first fibular free flap (FFF) was performed by Taylor et al. Received: 09 November 2020 Accepted: 16 December 2020 Published: 30 March 2021. Keywords: Fibula free flap head and neck reconstructive surgery microvascular surgery The fibula free flap continues to be extremely important for head and neck reconstruction, due to its reliability, versatility, and ability to place dental implants for total dental rehabilitation. By utilizing these techniques, we have found we are able to perform fibula free flap reconstruction more efficiently, with less staff, less complications, and are able to utilize less opioids post operatively. Opioid use after surgery can be reduced by utilizing multimodal pain management strategies, including use of regional anesthesia blocks and indwelling catheters. Utilizing step down units, instead of the intensive care unit (ICU), can also help avoid common complications such as pneumonia and delirium, as well as reduce costs. Post operatively, by utilizing enhanced recovery after surgery protocols one can standardize care, which can produce more consistent results. Virtual surgical planning, SPY angiography, and the WalterLorenzTM Surgical Assist Arm are all examples. Many adjuncts can facilitate easier harvest, inset, and monitoring. Pre operatively one must evaluate perfusion to the foot, as well as vasculature supplying the flap. Its advantages are its size and length, ability to utilize both hard and soft tissues, and its distance from the head and neck which allows for a two team approach. Abstract: The fibula free flap is a reliable reconstruction option, also known as the “work horse” of mandibular reconstruction.

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