Sequential connection of flaps: a logical approach to customized mandibular reconstruction

Area of Science:

• Reconstructive Surgery
• Head and Neck Surgery
• Microsurgery

Background:

• Mandibular reconstruction requires not only bone restoration but also adequate oral lining for function.
• Current osteocutaneous free flaps have limitations in bone length, contouring, and providing thin oral lining.
• Combined free flaps offer a solution by integrating strengths of different donor sites.

Purpose of the Study:

• To evaluate the efficacy of a combined fibular osseous flap with radial forearm or lateral arm flap for mandibular composite defects.
• To address limitations of traditional osteocutaneous flaps in head and neck reconstruction.
• To improve functional and aesthetic outcomes in complex reconstructive cases.

Main Methods:

• A sequential free flap technique was employed in six patients.
• A fibular osseous free flap was combined with either a radial forearm or lateral arm flap.
• The fibula's vascularity (distal peroneal vessels) supplied the second free flap, enabling anastomosis.

Main Results:

• Successful reconstruction of mandibular composite defects was achieved in all six patients.
• The combined flap approach provided both adequate bone stock and thin oral lining.
• This technique facilitated improved tongue mobility and prepared for future dental restoration.

Conclusions:

• Combining fibular osseous flaps with radial forearm or lateral arm flaps is a viable strategy for complex head and neck mandibular reconstruction.
• This method customizes reconstruction, addressing functional and aesthetic needs.
• The technique is particularly useful in cases with limited vascular access, such as post-radiation or post-surgery scenarios.