Reconstructing Segmental Mandibular Defects: A Single-Center, 21-Year Experience with 413 Fibula Free Flaps

The fibula free flap (FFF) is a common choice for mandibular reconstruction after oncologic resection. Advances in technology and surgical technique have changed the workflow of FFF-based mandible reconstruction. This study characterizes an institutional experience with these changes and their impact on patient outcomes.

A 21-year retrospective review was performed of patients who underwent segmental mandibulectomy with FFF-based reconstruction.

401 patients underwent reconstruction with 413 free flaps, with a median follow-up period of 2.9 years. Over the study period, there was an upward trend in case volume, with an average procedure length of 675.6 ± 132.5 minutes. Mini-plates ( n = 340 [82.3%]) were most commonly used for flap fixation initially, but reconstruction bars ( n = 73 [17.7%]) later became the preferred fixation method. A total of 168 (40.7%) patients had surgical planning with computer-aided design and manufacturing. A total of 98 (23.7%) patients underwent immediate dental implant placement. As computer-aided design and manufacturing and immediate dental implant placement became more prevalent during the study period, dental rehabilitation rates increased. A total of 226 (54.7%) patients experienced a complication at the recipient site, 122 (29.5%) of which required operative management; the rate of complications showed no discernable trend during the study period. The overall flap success rate of this cohort was 97.8%, with an all-cause mortality rate of 43.6%.

This study presents an institutional series of FFF-based mandible reconstruction in the 21st century. Advances in surgical technique and technology have improved operative workflow and patient outcomes; however, postoncologic mandible reconstruction remains a highly morbid procedure.