Reconstruction of mandibular defects with revascularized free rib grafts

Two cases of hemimandibular reconstructions with revascularized free rib grafts are presented. The viability of the transplants was confirmed by bone scans and biopsy, even though the main nutrient vessels providing the intramedullary blood flow were not included in these grafts (and only the periosteal circulation was utilized). The removal of a rib graft without the nutrient vessel eliminates the need for a complicated posterior dissection, close to the costovertebral joint. Revascularized free bone grafts have a greater chance of survival, provide more rapid healing, offer less risk of absorption, and are more resistant to infection than conventional bone grafts.