Single-Double-Single Barrel (1-2-1) Fibula Free Flap Design for Functional and Aesthetic Brown Class III Mandibular Reconstruction.

This novel hybrid single-double-single barrel (1-2-1) design for fibula free flap reconstruction addresses the unique challenges presented by Brown class III mandibular defects, which involve long-span defects at both bodies of the mandible and the chin. The importance of this design lies in its ability to overcome the limitations of traditional approaches in terms of mandible height and pedicle length, while optimizing both functional and aesthetic outcomes.The technique uses a combination of single-double-single barrel fibula segments to achieve ideal aesthetics and support for dental prosthesis across different areas of the mandible. At the chin, a double-barrel design provides proper chin and lower lip projection and supports dental prosthesis at the alveolus, and single-barrel segments are used for the mandibular bodies to allow adequate restorative space for dental rehabilitation and save the pedicle length. Favorable outcomes were demonstrated in terms of flap survival, dental implant osseointegration, bony healing, facial aesthetics, and occlusal rehabilitation. By addressing both functional and aesthetic requirements, this technique represents an important advancement in mandibular reconstruction for complex Brown class III defects. The approach showcases the potential of computer-assisted surgery and innovative flap designs to improve patient outcomes in challenging reconstructive scenarios.