A Cost-Effective Strategy for Mandibular Reconstruction: Fibula Flap With Existing Titanium Plates

With the rapid advancement of digital and microsurgical techniques, immediate autologous bone grafting following resection of benign and malignant mandibular tumors has become a standard treatment. However, some patients are unable to undergo immediate autologous bone grafting due to various reasons. In such cases, titanium plate implantation (or combined with soft tissue free flap such as anterolateral thigh flap) serves as an alternative to prevent airway compression and maintain facial shape and function. This article reports a case of a patient, referred to as patient 1, who experienced a recurrence of mandibular leiomyosarcoma and was unable to undergo immediate autologous bone grafting. Instead, an immediate titanium plate implantation was chosen to restore the patient's facial contour and esthetics. Although this method addresses functional and esthetic issues in the short term, a high risk of titanium plate exposure, which is shown in patient 2, adversely affects life quality. After systematic evaluation, the decision was made to retain and continue using the original titanium plate and screws and perform autologous fibula flap transplantation to repair the mandibular defect. Surgical procedures included titanium plate removal and debridement, bilateral partial mandibular resection and osteoplasty, preparation of the free fibula flap, and placement with fixation using the original titanium plate. Postoperative follow-up showed successful flap healing without complications, and the patient was satisfied with her postoperative appearance. This innovative strategy, under strict indications, can reduce the financial burden on patients, maintain occlusal relationships, and significantly improve postoperative quality of life.