Case report:
A 63-year-old man had the oral cancer history, and underwent the multiple times free flap surgery, including 3 times free fasciocutaneous flap and once free fibula osteoseptocutaneous flap reconstruction surgery. The free fibula flap from left leg failed due to venous congestion. It finally resulted in the segmental mandible bone defect, chin deformity and mouth incontinence with drooling.

We plan to do the turn-over flap using the prior flap skin paddle to restore the oral cavity inner lining, and harvest free fibular osteoseptocutaneous flap to reconstruct the mandible and cover the outer soft tissue defect. Before the surgery, we used the 3D mandible model to bend the reconstruction plate, and plan to do 3 osteotomies, including 2 osteotomies at symphysis area and 1 osteotomy at mandibular angle.

We encountered the difficulty when put the reconstruction plate which was too wide into the defect. If we want to make all things match, then we should create more space in oral cavity that would result in one more free flap for intra-oral defect. So, we abandoned the 3D model plate which need 2 osteotomies at symphysis area, then changed the design to make only 1 osteotomy at symphysis area as a V-shape and fixed the bone with reconstruction plate.

We realized that there are some advantages of V-shape design, such as more easily to fix the bone on the plate and can save one osteotomy.

At last, the free fibula osteoseptocutaneous flap survived well with secondary bone healing. Although the patient still had the mouth incontinence, he could use the straw to drink and had decreased drooling.

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