[Free-flap fibula for the reconstruction of composite mandibular defects]

The advent of microsurgery has revolutionized the reconstruction of composite tissue defects of the mandibular region. Well-vascularized bone and soft-tissues can be used to repair any kind of oromandibular defects and many of the morphological and functional goals of mandibular reconstruction can now be achieved. The ideal flap should provide a vascularized bone of sufficient length and height, easily shaped to match the original mandible with a thin, abundant soft-tissue component. The donor site morbidity should be minimal and a two-team approach possible. Different flaps have been used for mandibular reconstruction including fibula, iliac crest, radius and scapula. According to us, fibula free-flap satisfies many of these requirements and is the flap of choice in most cases of difficult mandibular reconstruction. 8 fibula free flaps were used in 6 cases of primary and 2 cases of secondary reconstructions. The defects were secondary to resections of oral cancers in 4 cases and of osteosarcomas in 4 cases. The mandibular defects were between 8 and 16 cm in length. Multiple osteotomies were used to shape the bone and miniplates were utilized for rigid fixation of the osteotomized bone and of the remaining mandible. An important soft-tissue defect was present in 6 cases requiring a skin paddle for oral lining. In 6 cases there was a complete survive of the flaps with very satisfactory results and good mandibular contour. There was one flap failure for a venous thrombosis and in one case the flap was removed after 8 days for complications independent of the microvascular technique. Donor site morbidity was minimal with no significant gait disturbance. In conclusion, the advantages of microvascular surgery and the reliability of fibula free-flap make it an attractive and versatile option in one-stage reconstruction of composite tissue defects in the mandibular region.