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Mandibular Reconstruction with Free Vascularized Fibular Graft
Nobuharu Yamamoto1, Takamichi Morikawa1, Takashi Yakushiji2
1Department of Oral and Maxillofacial Surgery, Tokyo Dental College.
The Bulletin of Tokyo Dental College
|October 19, 2018
Summary
Free vascularized fibular grafts offer advantages for mandibular reconstruction, achieving good engraftment in most cases. However, this technique is not suitable for all patients, particularly those with radiation osteomyelitis.
Area of Science:
- Oral and Maxillofacial Surgery
- Reconstructive Surgery
- Biomaterials Science
Background:
- Iliac block grafts are standard for mandibular reconstruction but have limitations.
- Free vascularized fibular grafts (FVFG) are emerging as an alternative.
- This study evaluates FVFG for mandibular reconstruction at Tokyo Dental College Chiba Hospital.
Purpose of the Study:
- To report the advantages and challenges of using free vascularized fibular grafts for mandibular reconstruction.
- To assess the outcomes and identify limitations of FVFG in a clinical setting.
Main Methods:
- Retrospective analysis of 8 patients undergoing mandibular reconstruction with FVFG (Jan 2003-Jan 2017).
- Patients' demographics, primary diseases, defect classifications (CAT system), and resection ranges were recorded.
- Surgical techniques (single/double barrel) and flap survival rates were analyzed.
Main Results:
- Complete engraftment was achieved in 6 out of 8 patients (75%).
- Two cases of radiation osteomyelitis of the mandible experienced necrosis.
- Advantages include safe conditions and functional recovery; disadvantages involve unsuitability for radiation osteomyelitis and extensive soft tissue resection.
Conclusions:
- Free vascularized fibular grafts are a viable option for mandibular reconstruction, offering functional recovery.
- Careful patient selection is crucial, as FVFG is not appropriate for all cases, especially radiation osteomyelitis.
- Further research is needed to establish definitive selection criteria for this reconstructive method.
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