Background and objectives: The vascularized free fibula flap has become the most popular reconstruction method for segmental mandibular defect because of adequate bone graft length and acceptance of dental implants. While because of the height discrepancy between the native mandible and transplanted fibula, it is difficult to wear conventional dentures or do osseointegrated implants. This study compared three methods of resolving this problem.

Methods: 18 patients underwent fibula flap reconstruction because of segmental mandibular defect. These patients were divided into three groups with three different methods to resolve the problem of height discrepancy after fibula flaps. 10 patients in the first group, the fibula was fixed 0.5–1 cm higher than the lower border of the native mandible; 5 patients in the second group, vertical distraction of the transplanted fibula was used; 3 patients in the third group, double barrel vascularized fibula flaps were used.

Results: The first group could improve the height of the fibula resulting in a shorter face, especially when the defect is located in the symphysis. The height of fibula and quantity of soft tissue was improved effectively in the second group, while two further operations should be suffered to position and take off the distractor. Furthermore, the extent of distraction is limited. In the third group, double barrel fibula could reconstruct mandible with perfect height and contour in single operation, especially with the assistance of computer-assisted techniques. For the reconstructive surgeon, it is very difficult to reconstruct large mandibular defects with double barrel vascularized fibula graft.

Conclusion: With the assistance of computer-assisted techniques, double barrel fibula is a good choice to reconstruct mandible and achieve perfect height and contour in single operation.