Mandibular reconstruction with microvascular fibular flaps after large resections: Towards a functional and cosmetic goal

Abstract

Reconstruction after resection for intraoral malignancies has improved significantly following the widespread use of micro vascular flaps. Mandibulectomy involving more than a small segment of the bone will always leave a significant cosmetic and functional defect. Reconstruction with skin and soft tissue flaps alone results in considerable deviation of the jaw, difficulties in mastication and speech and a less than ideal result. Vascularised bone transfers have now become the mainstay of reconstruction in such defects and the free fibular transfer has become the flap of choice worldwide. The requirements are usually for combinations of loss of bone, lining, cover and soft tissue for volume. In this paper, we present our consecutive series of 59 patients who underwent a free fibula transfer for reconstruction after mandibulectomy where the defect involved loss of more than 2 components outlined above. The indications, details of the defects, modifications of the surgical technique, complications, and donor site morbidity and outcome are discussed and the literature reviewed. The free fibular osteocutaneous flap appears to be the ideal flap for postmandibulectomy defects due to its reliability, versatility and ability to be contoured to the mandibular shape as well as the associated amount of skin and soft tissue that can be harvested with it.