Free double-barreled fibula osteoseptocutaneous flap with primary osseointegrated dental implants used to reconstruct a compound segmental mandibular defect from ameloblastoma resection. A. Left parasymphyseal segmental mandibulectomy with contiguous dentition and oral lining. B. The osteotomized fibula osteoseptocutaneous free flap ready to be double-barreled; note that a segment of bone between the two struts (barrels) has been discarded to allow safe folding of the construct without compression or kinking of the intervening periosteal blood supply. C. Segmental reconstruction of the resected inferior alveolar nerve with a cutaneous nerve graft from the fibula donor site to restore mentolabial sensation; note the extent of the segmental mandibular defect. D. Three osseointegrated dental fixtures have been loaded into the upper barrel of the fibula; abutments are fitted to the fixtures to allow accurate occlusal matching with the corresponding maxillary dentition before finalizing fibula fixation. E. The de-epithelialized portion of the skin paddle was used to cover the reconstruction plate as well as to contour the soft tissue profile of the neomandibular margin. F. The skin paddle has been inset to reconstruct the oral lining; note that the fibula osteoseptocutaneous flap is best raised with a skin paddle even when there is no cutaneous defect so that it can provide a sentinel flap monitor of the underlying bone as well as facilitate wound closure. At this point, the dental fixtures are sealed with cover plates under the flap skin paddle but will later be fitted with final abutments and a dental prosthesis. G. Panorex radiograph: By 5 months postoperatively, the fibula had consolidated with the native mandible. H and I. At 10 months, the patient has an aesthetic neomandibular margin as well as functional and accurate occlusion after finalization with a dental prosthesis. (Photographs reproduced with permission from F. Wei.) Source: Plastic and Reconstructive Surgery, Schwartz's Principles of Surgery, 10e Citation: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery, 10e; 2014 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/Books/980/bru_ch45_f039e.png&sec=100406049&BookID=980&ChapterSecID=59610887&imagename= Accessed: September 29, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved