FIBULAR FREE-FLAP RECONSTRUCTION OF THE TRUE LATERAL MANDIBULAR DEFECT

The purpose of this study was to determine the role of the fibular fre e flap in reconstructing lateral segmental defects of the mandible. Ov er the past 5 1/2 years, 17 consecutive patients underwent reconstruct ion of their lateral mandible with the fibular free flap. Patients inc luded 12 men and 5 women, the mean age was 54 years (range, 29-76 year s), and the mean length of the mandibular defect was 6.3 cm (range, 2. 5-9 cm). The majority of patients with tumors (54%) were treated for r ecurrence and 92% received radiation to the operative field. The mean operative time to perform the microsurgery and bone plating was 4 hour s. Postoperative morbidity occurred in 3 patients (18%) (plate fractur e, malocclusion, orocutaneous fistula). Five patients (29%) required l eg donor site skin grafting. Donor site morbidity included a minor cel lulitis, a transient neuropraxia, and one case of leg swelling. None r equired additional surgery for donor complications. Thus far, 71% of t he patients have received dental rehabilitation and 35% had osseointeg rated implants placed in their bone flap. Eighty-two percent of the pa tients achieved both good or excellent aesthetic and functional result s. Sixteen patients (94%) tolerate at least a soft diet and 65% are an a regular diet. Five patients developed tumor recurrence an average o f 9 months postoperatively with a mean survival of 21 months. This stu dy demonstrates that the fibular free flap is highly reliable for reco nstructing the lateral mandible in a single stage, with low overall mo rbidity, and provides for excellent dental and speech rehabilitation. For most patients, the fibular free flap should be considered for late ral mandibular reconstruction even in those patients with a limited li fe expectancy.