Late Donor-Site Complications Following Free Fibular Flap Harvest: A Report of a Rare Case

Mandibulectomy with free fibular flap reconstruction is a well-established procedure in head and neck surgery, recognized for its functional and aesthetic outcomes. However, this procedure carries certain risks, including the rare occurrence of late-onset donor site morbidities such as compartment syndrome. We report the case of a 67-year-old male with multiple comorbidities who developed compartment syndrome due to delayed hematoma formation at the donor site after undergoing segmental mandibulectomy with left fibular osteocutaneous free flap reconstruction. The patient, who was on antithrombotic therapy for ischemic heart disease, presented with severe calf pain and swelling on the 11th postoperative day, necessitating urgent surgical intervention. Hematoma evacuation and meticulous hemostasis led to a successful outcome. This case underscores the importance of thorough preoperative evaluation, precise surgical technique, and vigilant postoperative monitoring, especially in patients with significant comorbidities. Prompt recognition and management of delayed hematoma are essential to prevent further complications. Enhanced awareness and early intervention are critical in addressing this rare complication, and further research is warranted to establish standardized guidelines and identify specific risk factors for delayed hematoma formation.