Mandibular reconstruction with free tissue transfers

During the past ten years, immediate mandibular reconstruction has gradually fallen into disfavor because of the incidence of infection and the increasing use of preoperative radiation therapy. The difficulty lies in selection of the ideal material for mandibular replacement and the attainment of a healthy recipient bed. An attempt has been made to solve this problem with microsurgical techniques, and our experience in six free tissue transfers utilizing both free rib and free osteocutaneous groin flap transfers is reported. The evolution of these techniques has required confirmation of the feasibility of free flaps in the oral cavity as well as incorporation of a vascularized bone graft in free groin flaps. Based on this experience, the free osteocutaneous groin flap containing a vascularized portion of the iliac crest is preferred for reconstruction of combined and composite deficiencies of the lower jaw. Convincing demonstration of bone viability in composite flaps must await correlation of bone scans with tetracycline labelling.