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INFORMATION ABOUT
FIBULAR FREE FLAP
Information for patients and carers
If you require a large print, audio or translated copy of this
document please contact us on 020 3447 9755.
We will try our best to meet your needs.
Head & Neck Centre
Contents
Page No.
1 Introduction ............................................................ 3
2 What is a fibular free flap?...................................... 3
3 Are there any alternatives to this surgery? ............ 3
4 What does surgery involve? .................................. 3
5 What will my leg be like afterwards? ...................... 5
6 What can I expect after the operation? .................. 5
7 Will I have a scar?.................................................. 5
8 What are the possible problems? .......................... 5
9 Will my walking be affected?.................................. 6
10 Contact Details ...................................................... 7
11 Where can I get further information?...................... 7
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1 Introduction
This booklet has been designed to help you understand your
forthcoming treatment and contains answers to many
frequently asked questions.
If you have any questions that the booklet does not answer,
or would like further explanation, please ask one of the Team.
Please note that this booklet is only about a type of
reconstruction needed to fill the gap left by the removal of
tissue and should accompany an information booklet which
tells you about the way your cancer will be operated on.
2 What is a fibular free flap?
A fibular free flap is one way of filling a bony hole in either the
upper or lower jaw. It is one of the common ways of replacing
bone that has been removed during cancer treatment.
3 Are there any alternatives to this surgery?
There may be other types of reconstruction but your medical
team will be suggesting this one as thought to be the most
appropriate for you. Your medical team will be happy to
discuss the reasons for recommending this operation and any
other concerns you may have.
4 What does surgery involve?
Your surgeon will remove one of the bones from the lower
part of your leg. The fibular bone runs on the outside of the
leg from the knee joint to the ankle joint. It is a small thin
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bone that can be entirely removed without affecting your
ability to bear weight. The fibular bone is removed (the flap)
along with two blood vessels, one of which supplies blood to
the flap (the artery) and one of which drains blood from the
flap (the vein). Once the bone is raised, it is transferred to the
head and neck and secured in position with small plates and
screws. The blood vessels supplying and draining the flap are
then joined to blood vessels in your neck under a
microscope. These blood vessels then keep the flap alive
while it heals into its new place.
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5 What will my leg be like afterwards?
Your leg will be placed in a bandage following surgery.
Occasionally it is necessary to remove a piece of skin in
addition to the fibular bone. If the piece of skin that is
removed is large, it will need to be replaced with a skin graft
(please see leaflet on skin grafts).
6 What can I expect after the operation?
The area of your leg where the bone has been removed is
likely to be sore. Regular painkillers will be arranged for you.
A small tube is also placed through the skin into the
underlying wound to drain any blood that may collect. This
drain is usually removed after a few days.
7 Will I have a scar?
All cuts made through the skin leave a scar but the majority if
these fade with time. The scar on the outside of your leg runs
from just below the knee joint to just above the ankle joint.
8 What are the possible problems?
There are potential complications with any operation.
Fortunately, with this type of surgery complications are rare
and may not happen to you. However it is important that you
are aware of them and have the opportunity to discuss them
with your surgeon.

Bleeding since a drain is inserted into the

wound, bleeding is unusual.
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Infection you will be given antibiotics through a vein

whilst you are asleep and for the first few days after
surgery. As a result, infection is not normally a
problem.

Numbness sometimes you may notice a small

patch of skin on the lower part of your leg or foot that
is numb or tingly after the operation. This numbness
may take several months to disappear and in a
minority of patients may last forever.

Flap failure in 2 - 5% of cases, one of the blood

vessels supplying or draining the flap can develop a
blood clot within it. This means that the flap doesnt
get any fresh blood, or, if the drainage vein clots, then
the flap becomes very congested with old blood. It is
an occurrence that usually happens within the first
two days and means that you will have to return to the
operating theatre to have the clot removed. Removing
the clot is not always successful, and on these
occasions the flap fails and an alternative method of
reconstruction sought.
9 Will my walking be affected?
In the long term, removing the fibular bone should produce no
problems in walking. The physiotherapist will see you after
your operation and will help you mobilise as per your
surgeons instructions. In some cases you may not be able to
place any weight on the affected side for a short period. If this
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occurs, you may need some help from a walking aid, for
example a stick or a frame. If you still find mobilising difficult
on discharge from hospital, you may need some outpatient
physiotherapy to maximise your potential.
10 Contact Details
If you have any questions please contact the appropriate
healthcare professional secretary on 020 3447 9755. Your
message will be taken and passed onto the appropriate
department.
Head and Neck Cancer Centre
UCLH
1st Floor East
250 Euston Road
London
NW1 2PG
Email: headandneckcentre@uclh.nhs.uk
11 Where can I get further information?
If you would like more information you can also contact a
cancer support organisation such as:
Macmillan Cancer Support
89 Albert Embankment, London, SE1 7UQ
0808 808 2020 9am-9pm, Monday to Friday
Trained advisers can answer questions about living with
cancer and provide practical and emotional support.
email cancerline@macmillan.org.uk
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0808 800 1234 9am-8pm Monday to Friday
Cancer information nurse specialists can answer questions
about cancer types, treatment and what to expect following a
diagnosis.
Website: www.macmillan.org.uk
Features information about living with cancer, Macmillans
services and online communities in which people affected by
cancer can share experiences and support. Also includes a
link to www.cancerbacup.org.uk for detailed information about
cancer types and treatment.
Information is also available for free, 9am-9pm Monday to
Friday for other languages, call 0808 800 1234 and ask for an
interpreter.
Patient Information leaflet produced by the staff, patients and carers
associated with the UCLH Hospital
Publication date: May 2009
Date last reviewed: May 2011
Date next review due: May 2013
Leaflet code: UCLH/CS/H&N/CNS/FFF/1
University College London Hospitals NHS Foundation Trust
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