Reconstruction of posterior mandibular defects with soft tissue using the rectus abdominis free flap

Immediate reconstruction of posterior mandibular composite defects by replacement with vascularised bone is ideal in principle, but may have excessive morbidity for certain patients who, because of poor general health or a poor tumour prognosis, are not good candidates for a complex surgical procedure. Also, if the temporomandibular joint (TMJ) is missing, the continuity of the entire mandible cannot be restored without either reconstructing the TMJ or resorting to a prosthesis. For such patients, reconstruction of the posterior defect without bone using a rectus abdominis free flap or other soft-tissue flap may be a good alternative. A series of 21 patients with posterior mandibular defects underwent this type of reconstruction. The patients reconstructed only with soft tissue were found to have a reasonable cosmetic appearance, and speech and swallowing function were very acceptable. For posterior mandibular defects that include a missing condyle this approach is an acceptable alternative, especially for patients who are poor candidates for more complex surgical procedures.