Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Mandibular reconstruction is crucial for restoring form and function after defects.
• Microvascular free flaps offer versatile solutions for complex reconstructions.
• Comparing outcomes of different flap types is essential for optimizing patient care.

Purpose of the Study:

• To compare flap success rates, complications, and aesthetic/functional outcomes in 178 mandibular reconstructions.
• To evaluate the impact of bony and soft-tissue defect extent on functional results.
• To develop an algorithm for oromandibular reconstruction based on defect characteristics.

Main Methods:

• Retrospective analysis of 178 consecutive microvascular free flap reconstructions from 1979-1997.
• Classification of bony defects (HCL method) and soft-tissue defects (none, skin, mucosal, through-and-through).
• Assessment of deglutition, speech, and mandibular contour, with statistical analysis of functional outcomes.

Main Results:

• Total flap necrosis was significantly higher for ilium and fibula flaps compared to others (p < 0.05).
• Implant plate removal rate was 35.6% due to exposure or fracture.
• Significant differences in deglutition, speech, and contour were observed based on soft-tissue defect extent (p < 0.05).

Conclusions:

• The fibula flap is the preferred choice for anterior bony defects in mandibular reconstruction.
• Donor site selection should consider the extent of both bony and soft-tissue defects.
• An algorithm is proposed to guide reconstruction decisions, emphasizing the fibula for anterior and extensive defects.