The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Oncology

Background:

• Extensive through-and-through defects of the lateral face, involving skin, mandible, and mouth, result from ablating large intraoral cancers.
• Reconstruction necessitates addressing lips, mandible, and full-thickness cheek defects.
• Vascularized composite free flaps are ideal for complex reconstructions, requiring sufficient bone and versatile skin paddles.

Purpose of the Study:

• To review reconstructive options for extensive lateral facial-mandibular defects.
• To assess the outcomes of various free flap techniques in primary reconstruction.
• To emphasize the suitability of specific free flaps for complex soft tissue and bone requirements.

Main Methods:

• A retrospective review of 12 patients with large lateral facial-mandibular defects.
• Primary reconstruction using various free flap techniques: scapular (6), iliac crest (2), fibula (3), and radial forearm (1).
• Assessment of reconstructive goal attainment, flap survival, and complication rates.

Main Results:

• All 12 defects were successfully reconstructed in the primary setting.
• No free flap failures were reported; one venous occlusion was salvaged.
• No orocutaneous fistulas or postoperative hematomas occurred.

Conclusions:

• The study reviews reconstructive strategies for extensive lateral face and jaw defects, considering complex 3D soft tissue needs.
• The scapular composite flap is superior due to its dual, independent skin paddles and adequate bone stock.
• This flap offers versatility for resurfacing extensive intraoral and external defects.