Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps

The free fibula flap is the gold standard in reconstruction of oncologic mandibular defects. When the mandibular condyle is resected, reconstruction of the temporomandibular joint (TMJ) continues to pose a unique challenge to the reconstructive surgeon. Several conventional methods have been described, including costochondral grafts, bone grafts, and alloplastic prostheses. These nonvascularized options are rarely employed in the oncologic patient receiving postoperative radiation therapy due to high rates of resorption, nonunion, and failure. The authors describe a novel technique for mandibular and TMJ reconstruction utilizing the fibula free flap as a flow through for a medial femoral trochlea flap for vascularized mandible and condylar reconstruction. This technique provides a vascularized cartilaginous surface to articulate with the glenoid fossa, making it an attractive option for the oncologic patient undergoing postoperative radiation therapy.