Vascularized bone graft is most resistant to oral infection and adjuvant postoperative
radiotherapy. The aim of this study was to use a pedicle bone graft and free skin
flap for compound mandibular reconstruction following ablation of head and neck tumors.
Ten patients received pedicle bone graft and free skin flap transfer for compound
mandibular defects after tumor ablation from January 2003 to March 2005. All were
males with an average age of 50 years. The mandibular defect ranged from 3 to 6 cm,
averaging 4.6 cm in length. The intraoral defect ranged from 6.4 to 12.8 cm in size.
One patient had a through-and-through defect. The cheek defect was 8.7 cm2 in size. The mandibular defect was reconstructed with either horizontal or split
sliding osteotomies from the remaining mandibular fragments. All the sliding fragments
were attached with well-vascularized muscle flaps. The remaining soft tissues defects
were reconstructed with 7 anterolateral thigh flaps, 2 radial forearm flaps, and 1
tongue pedicle flap. Postoperative bone scans and x-rays of the mandible were performed
for evaluation of bone viability and bone union.
Mandible symmetry and occlusion were preserved in all the patients. Nine received
free skin flap reconstructions. One patient had a failure due to artery insufficiency
and needed another anterolateral thigh flap reconstruction. Six of nine patients received
the bone scan at 1 week postoperative, revealing good vascularization of the transferred
bone. All patients had stable union of bone, except for one who developed osteomyelitis
of the mandible requiring surgical treatment. Two patients had deep neck infections
and were treated successfully with aggressive antibiotics. Eight patients had postoperative
radiotherapy. There was no osteoradionecrosis found.
The procedure is quick and secure for reconstruction of small to moderate defects,
and can achieve bone union and good contour of the mandible. There is no additional
morbidity of donor sites from the leg or ilium.
