Central mandibular defects require reconstruction considering the shape and function. In younger patients with many residual teeth, vascularized bone grafts should be selected to maintain mandibular function using dentures and implants. The double-barrel method with a fibula flap can achieve high-quality mandibular reconstruction; however, most reports describe its application for unilateral mandibular defects because of its technical difficulty. We report a 52-year-old woman who underwent reconstruction of a central mandibular defect using the double-barrel method with osteoseptocutaneous fibula flap surgery. Four pieces of the fibula were built into the shape of the mandible at the donor site. We describe our design and strategies, including the semi-open-wedge technique.
