A-O reconstruction plate and sternal osteomyocutaneous flap in primary mandibular reconstruction

Mandibular arch reconstruction remains a functional and aesthetic challenge for the head and neck surgeon. The recent popularity of vascularized free composite flaps has made them a first choice for many surgeons. However, the increased operating time, high failure rate, frequent need for operative rescue, specialized postoperative care and facilities, and specialized training required to perform them have prompted many extirpative surgeons to attempt other techniques or to leave the mandible unreconstructed. Six sternal osteomyocutaneous flaps, a variant of the familiar pectoralis major myocutaneous flap, were utilized to reconstruct mandibular defects of up to 10 cm in patients undergoing composite resection for cancer, with or without preoperative radiotherapy. The use of the A-O reconstructive plate to secure the bony portion of the flap to the unresected mandible has considerably simplified and speeded the procedure over external fixation as originally described. When both soft tissue and bone are required to rehabilitate the operative defect, the sternal osteomyocutaneous flap has proven to be a reliable and time-effective procedure.