Medical Oncologist
CION Cancer Clinics
Fibula free flap: rebuilding the jaw with bone from the leg | CION Cancer Clinics
A fibula free flap replaces a removed section of jawbone with the thin outer bone of your lower leg. The bone is moved with its own blood vessels, which are joined to vessels in your neck so it stays alive and heals into the jaw. Most people walk well afterwards. This page explains how it works, who it may not suit and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is a fibula free flap, and why use the leg to rebuild the jaw?
- What are the other ways to rebuild the jaw?
- What happens before, during and after the operation?
- What do the words on the plan mean?
- What do families worry about, and what is actually true?
- What can this page not tell you, and what should you ask?
- Common questions about fibula flap jaw reconstruction
The short answer
What is a fibula free flap, and why use the leg to rebuild the jaw?
A fibula free flap rebuilds a missing piece of jawbone with the thin outer bone of your lower leg. The bone is moved with its own artery and vein, which are joined to blood vessels in your neck so the new jaw stays alive.
Why this bone is chosen so often
The fibula is long and straight. It can be cut into short pieces and angled to follow the curve of your chin and jaw. Your leg carries most of your weight through the other, larger bone, so most people walk well without the fibula. A strip of skin from the leg can come with the bone to line the inside of the mouth where tissue was removed.
What "free" means
A free flap is tissue fully detached from its first home and carried to a new one. The surgeon joins its tiny blood vessels to vessels in the neck under a microscope. If that join works, the bone heals into the remaining jaw much like a broken bone heals.
Who it may not suit
It is not right for everyone. Poor circulation in the legs, some earlier leg injuries or operations, and serious heart or lung problems can make another option safer. Some people are offered bone from the hip or shoulder blade, or a metal plate with soft tissue only.
Your team will usually scan the blood vessels in both legs before deciding which side to use.The options your team weighs
What are the other ways to rebuild the jaw?
The choice depends on how much bone is missing, where it sits, the state of the skin and gums, and your general health.
Fibula from the leg
The longest piece of bone available. It holds dental implants well once healed and can replace a large section of the front or side of the jaw.
Often chosen when
- The front of the jaw is removed
- A long segment is missing
Hip bone (iliac crest)
A thicker, curved bone that naturally resembles the jaw. It gives a good base for teeth, but the hip can stay sore for longer and the piece is shorter.
Shoulder blade (scapula)
A thinner bone with a lot of soft tissue attached. It is often considered when the leg vessels are poor or a person needs to be on their feet early.
Plate with soft tissue only
A titanium plate bridges the gap and a flap of skin and muscle covers it, without any new bone. The operation is shorter, but the plate is more likely to work loose or show through over time.
This is sometimes the safer choice for a person who cannot manage a long operation.Not sure whether this applies to you?
Ask an oncologistFrom planning to going home
What happens before, during and after the operation?
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Planning scans
A CT scan of the jaw and a scan of the leg blood vessels. Some teams use computer planning or printed models to decide exactly where the bone will be cut and shaped.
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The operation
Two teams often work at once, one removing the cancer and one taking the leg bone. It is a long operation that usually takes up most of a day. A breathing tube in the neck (tracheostomy) is common, so you can breathe safely while the mouth and throat are swollen.
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The first days
You are watched closely, often in intensive care or a high dependency unit. Nurses check the flap regularly for colour and blood flow, day and night. Food comes through a feeding tube.
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Getting up and eating
A physiotherapist helps you stand and walk with support. A speech and swallowing therapist guides the move from tube feeds back to soft food by mouth.
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Home and follow-up
Stitches, the leg wound and the neck tube are checked at clinic. Radiotherapy may follow if the pathology report shows a need for it.
On your notes
What do the words on the plan mean?
- Segmental mandibulectomy
- Removal of a full-thickness section of the lower jaw, so the bone no longer joins up on its own.
- Osteocutaneous flap
- A flap carrying bone and skin together, used when the lining of the mouth also needs replacing.
- Microvascular anastomosis
- The join between the flap's tiny blood vessels and the vessels in your neck, sewn under a microscope.
- Flap monitoring
- Regular checks of colour, warmth and blood flow in the flap during the first days.
- Margin
- The rim of healthy tissue around the cancer that was removed. A clear margin means no cancer cells were seen at the edge.
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What cannot wait, in hospital or at home
In the first days, if the flap inside the mouth turns dark, purple, pale or cold, or the neck swells quickly, tell the nurse at once. It can mean the blood supply is blocked, and a quick return to theatre can sometimes save the flap. At home, noisy or difficult breathing, fresh bleeding from the mouth or neck, or a leg that becomes hot, red and swollen needs the nearest emergency department the same day.
Commonly believed
What do families worry about, and what is actually true?
"Taking the leg bone means he will never walk properly again."
The fibula carries very little of your weight. Most people walk without a stick once the leg wound has healed, though the ankle can feel stiff or weak for some months. Physiotherapy makes a real difference, so keep to the exercises.
"Rebuilding the jaw is only for looks, so we can skip it."
The jaw holds the tongue forward, supports chewing and swallowing and helps keep the airway open. Losing a front section without rebuilding it can badly affect eating and breathing, not just appearance.
"If the flap fails, nothing more can be done."
Flap loss is a known risk, and it is upsetting when it happens. It is rarely the end of the road. Your team can often use a second flap or a different method, and will explain the choice with you.
"She will have teeth straight after the operation."
Dental implants in the new bone are sometimes possible, but usually only after the bone has healed and any radiotherapy has finished. Some people never have them. Ask about it before surgery so the plan allows for it.
Being straight with you
What can this page not tell you, and what should you ask?
This page cannot tell you whether a fibula flap is right for you or your parent. That depends on the scans, the size and position of the cancer and the health of the heart, lungs and legs. Only your treating team, looking at all of it together, can weigh that.
Questions worth taking to the surgeon
Ask why this method was chosen over the others. Ask which leg will be used and why. Ask whether a neck breathing tube is planned, how long a hospital stay your team expects, and who checks the flap at night. Ask whether implants for teeth are part of the long-term plan.
For the son or daughter organising care
Plan for someone to stay close in the first weeks at home. Soft food, help on the stairs and trips back for dressing checks are all normal. If you live in a district far from Hyderabad, ask the team early which problems can be seen locally and which need you to come back.
Nothing on this page replaces the consent discussion with your own surgeon.Questions we are asked
Common questions about fibula flap jaw reconstruction
Will my face look normal after a fibula flap?
The aim is to keep the shape of the lower face as close to before as possible. Most people look different at first, mainly because of swelling, which settles over weeks. Some fullness or flattening may stay, especially after radiotherapy. Your surgeon can explain what is realistic for the amount of bone being removed.
How long will I be in hospital?
It varies with the size of the operation, whether a neck breathing tube is used and how quickly swallowing returns. Most people stay longer than for an operation on the mouth alone. Ask your team for their usual range, and plan for a family member to be free through that period and the first weeks at home.
Can I eat normally again?
Many people go back to eating by mouth, starting with liquids and soft food. Chewing hard food can stay difficult, especially without teeth on the rebuilt side. A swallowing therapist helps you find safe textures. Some people need a feeding tube for longer if radiotherapy follows.
Which leg do they take the bone from?
It depends on the blood vessels in each leg, which side of the jaw is being rebuilt and sometimes which leg you use most for driving or work. The planning scan shows which leg has the healthier vessels. It is fair to tell the surgeon if one leg matters more to you in daily life.
Will the metal plate stay in forever?
Usually yes. Small titanium plates and screws hold the pieces of bone in place while they heal, and most stay in for life without trouble. Sometimes a plate becomes exposed in the mouth or on the skin, or gets infected, and then it may need to be removed or replaced.
Can radiotherapy be given after a fibula flap?
Yes. Radiotherapy is often given after this operation when the pathology report shows a need for it. It usually starts once the wounds have healed. Radiation can slow healing and make the tissues stiffer, so your surgeon and radiation oncologist plan the timing together.
My father is diabetic and smokes. Can he still have it?
Diabetes and smoking both raise the risk of the flap and the wounds not healing well. They do not always rule the operation out. Stopping smoking as early as possible and keeping blood sugar steady both help. His team will weigh these alongside his heart, lungs and leg vessels.
Is it covered by Aarogyasri or insurance?
Cancer surgery with reconstruction is often covered when it is part of an approved treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Call the helpline with your card details so cover can be checked before admission.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Sources
- Cancer Research UK — Surgery for mouth and oropharyngeal cancer
- NHS — Mouth cancer: treatment
- National Cancer Institute — Lip and Oral Cavity Cancer Treatment (PDQ) - Patient Version
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Walking After a Fibula Flap: The Leg Donor SiteWhat to expect from the leg the bone came fromReconstruction Plates for the JawThe titanium plates that hold the new boneDental Implants After Jaw ReconstructionWhen teeth can be added to the rebuilt jawICU and the First Days After SurgeryWhat the first days of close watching look like
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