Split-thickness skin grafts directly to bone for marginal mandibulectomy reconstruction: a case series

Oncologic resection of oral cavity malignancies can result in defects requiring epithelial coverage. While microvascular free flaps are considered the gold standard, split-thickness skin grafts (STSGs) offer a simpler alternative for selected marginal mandibulectomy defects and patients. This case series describes the use of STSGs to reconstruct marginal mandibulectomy defects at a tertiary Australian head and neck oncology service between April 2019 and October 2024. Eleven patients underwent resection and immediate reconstruction with STSGs. Bolstering techniques included prefabricated partial dentures and intraoperatively fashioned foam bolsters to support graft take. All patients achieved successful graft take. Minor complications occurred in four patients. This included small areas of bone exposure and donor site discomfort, which were managed conservatively. All patients who desired further dental rehabilitation were able to receive this with either implant-supported or removable prostheses, maintaining functional speech and oral intake. These findings highlight STSGs as a viable primary reconstructive option for marginal mandibulectomy defects. They may also be applicable as a reconstructive alternative in medically compromised patients or where microvascular reconstruction is contraindicated. Integrated within this report is a detailed technical note outlining surgical technique, bolstering strategies, and postoperative care to optimize outcomes.