Background and objectives: Primary microsurgical reconstruction is currently considered as first choice in the majority of maxillary/mandibular resections. Or objectives are to assess the refinements for the fibula flap and the different applications we used, to improve the outcomes and optimize surgical timing.

Materials and methods: A retrospective study is developed from a series of 100 patients treated in our Hospital from 1998 to 2012. The results are evaluated in terms of type of defect, fixation methods and complications, discussing the reconstructive peculiarities of each mandibular region.

Results: A total of 115 fibula flaps were performed. Mandibular symphysis was the most commonly reconstructed. Several fixation methods have been used: miniplates, reconstruction and medium profile plates. For design we used templates over CT 1 to 1, plate modeling directly over mandible, stereolithographic models, articulator assembly and computer designed cut guiding splints. The most frequent complications were related to the plates and screws.

Conclusions: The fibula free flap is one of the first choice procedures for mandibular reconstruction, being a safe technique with high successful rate. The localization of the defect determines the reconstruction and must be carefully considered.

Key words: reconstruction; fibula flap; indications; refinements