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The free fibula bone graft for salvaging failed mandibular reconstructions
J P Anthony1, R D Foster, M A Pogrel
1Division of Plastic and Reconstructive Surgery, University of California at San Francisco 94115-1632, USA.
Summary
Vascularized free fibula bone grafts effectively salvage mandibular function and aesthetics after failed reconstructions. This reliable technique offers successful outcomes even in complex cases with prior reconstructive failures.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Head and Neck Surgery
Background:
- Mandibular reconstruction presents challenges, particularly after failed initial attempts.
- Previous reconstructive failures may involve multiple procedures and radiation therapy.
- Salvaging mandibular function and aesthetics requires robust reconstructive solutions.
Purpose of the Study:
- To evaluate the efficacy of vascularized free fibula bone grafts in mandibular salvage reconstruction.
- To assess functional and aesthetic outcomes following fibula graft reconstruction.
- To determine the reliability of this technique in complex, previously operated cases.
Main Methods:
- Seven patients underwent vascularized fibula grafts for mandibular reconstruction after prior failures.
- Patients had an average of 20 prior operative procedures and some had radiation history.
- Functional and aesthetic outcomes were assessed via questionnaires and clinical examinations.
Main Results:
- 100% flap survival and successful soft tissue coverage and mandibular restoration were achieved.
- 70% of patients reported good or excellent functional results (speech, continence, swallowing).
- 70% of patients achieved good or excellent aesthetic outcomes (facial symmetry).
Conclusions:
- Vascularized free fibula grafts are effective for mandibular salvage reconstruction after failed attempts.
- This technique reliably restores mandibular function and aesthetics.
- Successful reconstruction is achievable even in complex cases with multiple prior failures, provided appropriate flap selection and patient stability.