Double-barrel vascularised fibula graft in mandibular reconstruction: A 10-year experience with an algorithm

Abstract

This retrospective study aims to report an algorithm to assist surgeons in selecting different modes of the double-barrel vascularised fibula graft for mandibular reconstruction. A total of 45 patients who underwent reconstruction of mandibular defects with different modes of the double-barrel vascularised fibula graft were reviewed. Our algorithm for deciding on any one of the different modes for different mandibular defects is influenced by factors including history of radiotherapy, the length of mandibular body defect and the need to preserve the inferior mandibular border. Post-operative functional outcomes included diet type and speech, and aesthetic results gained at post-operative 2 years. Patients with implant-borne prosthetic teeth underwent assessment of their masticatory function. There were four modes of mandibular reconstruction according to our algorithm, which included double-barrel vascularised fibula graft (n=21), partial double-barrel fibula graft (n=11), condylar prosthesis in combination with partial/double-barrel fibula graft (n=11), and double-barrel fibula onlay graft (n=2). Flap survival in all patients was 97.78%. Good occlusion, bony unions and wound closures were observed in 44 patients. Eleven patients received dental implantation in the transplanted fibula at post-operative 9-18th months. One patient wore removal partial dentures. For 11 patients with implant-borne prosthetic teeth, the average post-operative ipsilateral occlusal force was 41.5±17.7% of the contralateral force. Good functional and aesthetic results were achieved in 38 patients with more than 2 years of follow-up, including regular diet, normal speech and excellent or good appearance, especially for patients with dental rehabilitation. Good aesthetic and functional results can be achieved after dental rehabilitation by following our algorithm when choosing the different modes of double-barrel vascularised fibula graft for mandibular reconstruction.