Oromandibular reconstruction using microvascular composite flaps: report of 210 cases

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Oromandibular reconstruction presents complex challenges due to functional and aesthetic demands.
• Vascularized bone free flaps offer a robust solution for large bony and soft tissue defects.

Purpose of the Study:

• To evaluate the efficacy and outcomes of vascularized bone-containing free flaps in oromandibular reconstruction.
• To assess the success rates of dental implants placed in reconstructed mandibles.

Main Methods:

• Retrospective review of 210 vascularized bone free flap reconstructions performed by a single microvascular surgeon over 11 years.
• Flaps sourced from ilium, fibula, or scapula; some cases utilized simultaneous bilateral flaps.
• Endosteal dental implants were assessed for success rates, including in irradiated bone.

Main Results:

• Achieved a 96% success rate for mandibular continuity restoration.
• Overall dental implant success rate was 92%, with 86% success in postoperatively irradiated bone.
• Complications were minimal, with acceptable donor and recipient site morbidity.

Conclusions:

• Vascularized bone free flaps are highly successful for oromandibular reconstruction, restoring both form and function.
• Dental implants can be safely and successfully integrated into reconstructed mandibles.
• Early implant placement during reconstruction enhances dental rehabilitation and outcomes, particularly with radiotherapy.