A 20-Year Experience with 202 Segmental Mandibulectomy Defects: A Defect Classification System, Algorithm for Flap...

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Biomaterials Science

Background:

• Mandibulectomy defects require reconstruction considering both bone and soft tissue.
• Current reconstruction methods may not adequately address combined soft-tissue and bony deficits.
• A standardized approach is needed for optimal defect classification and flap selection.

Purpose of the Study:

• To establish a novel defect classification system for segmental mandibulectomy.
• To develop a flap selection algorithm emphasizing soft-tissue deficits.
• To evaluate surgical outcomes of the proposed reconstruction algorithm.

Main Methods:

• Retrospective review of 202 patients undergoing immediate mandibulectomy reconstruction (1992-2011).
• Analysis of bony and soft-tissue defect characteristics.
• Correlation of defect parameters with flap selection and surgical outcomes.

Main Results:

• 211 flaps were used; 81% were osseous and 19% nonosseous.
• Fibula flaps dominated osseous reconstructions (91%), while vertical rectus abdominis flaps were common for nonosseous (68%).
• Soft-tissue zone involvement significantly influenced flap choice, with more zones favoring nonosseous flaps.

Conclusions:

• A comprehensive algorithm integrating nonosseous and osseous flaps is crucial for mandibulectomy reconstruction.
• Increasing soft-tissue defect extent favors nonosseous flaps due to skin island reliability.
• The proposed algorithm yields comparable or superior outcomes to existing literature, representing a large single-surgeon experience.