Achieving mandibular continuity with vascular bone flaps: a comparison of primary and secondary reconstruction

This retrospective study was performed to compare the functional and aesthetic results achieved in two distinct groups of patients undergoing composite reconstruction of complex head and neck defects using vascularized bone flaps. Fourteen consecutive patients undergoing reconstruction over a 30-month period (January 1988 through June 1991), nine primary and five secondary, were analyzed. The two groups were similar with respect to age, physical status, tumor type and stage, exposure to radiation, and previous history of cigarette smoking and alcohol consumption. The bone defect was similar between the two groups, but the soft tissue deficit was greater in the group of patients reconstructed secondarily. Surgery time and blood loss tended to be less in the patients reconstructed secondarily, but length of hospitalization was similar. Flap survival was 100%, although the complication rate approached 60%. Restoration of mandibular continuity and orofacial soft tissue defects with vascularized composite free flaps had a favorable impact on function and aesthetics in the group of patients reconstructed primarily. In those reconstructed secondarily the benefit was primarily cosmetic. Continued emphasis on primary reconstruction of the composite defect with composite free tissue transfers is advised.