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Related Experiment Videos

Mandibular reconstruction: are two flaps better than one?

Essem Gabr1, Mark R Kobayashi, Arthur H Salibian

  • 1Aesthetic and Plasic Surgery Institute, The University of California-Irvine, Orange, 92868, USA.

Annals of Plastic Surgery
|December 17, 2003
PubMed
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The osteomusculocutaneous fibular free flap showed better outcomes than combined iliac/ulnar flaps for mandibular reconstruction. Fibular flaps resulted in fewer complications, higher survival, and improved function, making them preferable for most cases.

Area of Science:

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

Background:

  • Mandibular reconstruction is crucial for restoring function and aesthetics after cancer resection or trauma.
  • Various free flaps are utilized, each with distinct advantages and disadvantages.
  • Comparing the osteomusculocutaneous fibular free flap with combined iliac crest and ulnar forearm flaps is essential for optimizing patient outcomes.

Purpose of the Study:

  • To compare the efficacy of the osteomusculocutaneous fibular free flap versus combined iliac crest and ulnar forearm free flaps in mandibular reconstruction.
  • To evaluate flap survival rates, local complications, functional outcomes (speech, swallowing, chewing), and cosmetic results.

Main Methods:

  • A retrospective study of 40 patients undergoing oromandibular reconstruction.

Related Experiment Videos

  • Group 1: 23 patients received combined iliac crest and ulnar forearm free flaps.
  • Group 2: 17 patients received osteomusculocutaneous fibular free flaps.
  • Functional outcomes assessed using the University of Washington Questionnaire.
  • Analysis of patient demographics, defect characteristics, recipient vessels, hospital stay, flap survival, complications, and functional/cosmetic results.

    • Main Results:

    • Both flap types demonstrated high overall survival rates (96.8%).
    • Fibular flaps had significantly fewer local complications (5.9% vs. 30.4%) and a higher survival rate (100% vs. 95.65%) compared to iliac/ulnar flaps.
    • Patients receiving fibular flaps reported better speech, swallowing, and chewing function.
    • Cosmetic acceptance was rated excellent/good in 77.8% of fibular flaps versus 71.4% of iliac/ulnar flaps.
    • Mean hospital stay was shorter for fibular flaps (10.09 days vs. 15.43 days).

    Conclusions:

    • The free osteomusculocutaneous fibular flap is associated with fewer local complications, higher flap survival, and improved functional outcomes compared to combined iliac/ulnar forearm flaps for mandibular reconstruction.
    • The fibular flap appears to be a superior choice for most mandibular reconstructions, offering better functional and aesthetic results.
    • Combined iliac/ulnar flaps may be considered for very massive oromandibular defects where extensive tissue is required.