[Axial split osteotomy of free fibular flap for mandibular angle reconstruction: a clinical study]

To introduce an axial split osteotomy of free fibular flap for mandible angle reconstruction and discuss its indications and surgical technique.

16 patients underwent axial split osteotomy of free fibular flap(12 males and 4 females, aged from 23 to 62). 11 patients with benign tumors (8 ameloblastomas and 3 odontogenic keratocyst), 3 patients with osteoradionecrosis, and 2 patients with secondary mandibular deformity were included. The length of free fibular flap ranged from 10-17 cm (mean 14.6 cm). The length of the vascular pedicel ranged from 5-11 cm (mean 8.2 cm). The fibular flap harvested was performed in routine manner. After elevating the periosteum and performing minimal dissection at osteotomy site only, axial splitting was performed using an oscillating saw. The first osteotomy was made on the external surface of the fibula, perpendicular to the main axis of the bone down to the level of the medullary canal. The second osteotomy was made along the main axis of the bone. The length of this osteotomy was between 2 and 3 cm. The last osteotomy was made perpendicular to the internal surface at one junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first osteotomy. Then the harvested flap was contoured, which was achieved by raising the two bone segments and fitting them together. The angulation was 120 degrees.

16 flaps were monitored by Doppler ultrasound postoperatively and examined by colored ultrasound 3 months, 6 months after operation. The results revealed that the recipient sites healed primarily without complications.

Axial split osteotomy is a reliable technique with maximum contact surface for bone union, and less bone loss, which can lengthen the transplanted bone to a certain extent. It is suitable especially for reconstruction of the defect of the angle of the mandible.