ABSTRACT
Mandibular defects result from resection of tumors, osteomyelitic or osteoradionecrotic
lesions, or trauma. Soft tissue involvement surrounding the mandible results in even
larger and more complicated defects that require delicate shaping of the hard and
soft tissue components of the flaps used for reconstruction. Although the iliac crest
free flap and the scapula free flap can be used for reconstructing these defects,
the authors favor the fibula osteoseptocutaneous flap as it provides a large bony
segment that can be safely osteotomized and can be transferred with a reliable skin
paddle. For large defects missing multiple tissue components, more than one flap may
be required for an optimal reconstruction. The favored combination at this institution
is the fibula osteoseptocutaneous free flap along with the anterolateral thigh free
flap. In a selected group of patients osteointegrated implants are offered for eventual
dental implant placement. This can be performed during the primary operation in patients
with mandibular defects resulting from the excision of benign lesions and in some
nonbenign lesions with excellent prognoses; otherwise they are performed secondarily.
The harvest, contouring, and inset of the flap as well as accurate placement of osteointegration
implants are important for achieving a result that allows long-term functional results
and aesthetic success for the patient.
KEYWORDS
Mandible reconstruction - fibula flap - osteointegrated implants - microsurgical reconstruction
