THE FATE OF THE OSTEOTOMIZED FREE RADIAL FOREARM OSTEOCUTANEOUS FLAP IN MANDIBLE RECONSTRUCTION

The radial forearm osteocutaneous free flap has become a standard meth od of mandible reconstruction. In order to improve the contour of the reconstructed jaw in large resections, especially the anterior defect, the radial forearm bone graft needs to be osteotomized. The bone graf t is nourished by small branches of the radial artery via the fascial connections between the skin flap and bone. The effect of the osteotom y, fixation devices, and the angulation of the bone segment on bone vi ability and eventual bone healing is not known. Forty-two radial forea rm osteocutaneous flaps were used for composite mandible reconstructio n. In 25 patients, the bone graft required osteotomy to achieve bone c ontour, of which 16 required single osteotomy and nine required double osteotomy. In a remaining 17 cases, no osteotomy was performed. Only those patients who had at least a 1-year follow-up were included in th is study. The proportion of patients who achieved bone union was simil ar for both groups (i.e., osteotomy vs. non-osteotomy). Performing ost eotomies on the segment of the radius in free osteocutaneous transfers is safe, and it allows for more flexibility in reconstruction, to ach ieve a natural-appearing jaw.