[Personal experience in mandibular reconstruction with free flaps revascularized with "double barrel" fibula]

The introduction of microvascular surgical techniques with bone flaps has made it possible to restore first form and then function in patients undergoing post-oncological oromandibular resection. Revascularized bone differs from avascular grafts in that the residual mandibular stumps heal much more quickly, even in areas where trophism is poor due to prior surgery and/or radiation therapy. The fibula flap is easy to withdraw and permits two teams to work simultaneously. The bone tissue can be grafted well, is easy to shape and osteotomizes with acceptable donor site morbidity. Using the double barrel technique introduced by Bahr in 1994 the neo-mandibular reconstruction can be made to the ideal height, enabling graft-prosthetic rehabilitation and providing the ideal skeletal support for the soft tissues in the lower third of the face. The present case study reports on 7 patients who underwent mandibular reconstruction with fibula flaps using the double barrel technique at the Department of Maxillo-Facial Surgery in Parma, Italy between June 1995 and December 1999. All flaps were successfully transplanted and none of the cases showed partial necrosis of either the bone or skin flaps.