THE FREE FIBULA BONE-GRAFT FOR SALVAGING FAILED MANDIBULAR RECONSTRUCTIONS

Purpose: The purpose of this study was to determine the efficacy of va scularized free fibula bone grafts for mandibular salvage reconstructi on. Patients and Methods: Seven patients had fibula grafts after faile d attempts at mandibular reconstruction. The prior attempts involved 2 0 operative procedures. Four of the seven patients (57%) had a history of radiation to the affected mandible. Bony defects averaged 10.2 cm (range, 4.5 to 24 cm), and the associated soft tissue defects averaged 6 x 12 cm. Average follow-up was 16 months. Cosmetic (facial symmetry ) and functional (speech quality, oral continence, deglutition, donor site morbidity, dental rehabilitation) results were evaluated by quest ionnaire and clinical examinations. Results: Soft tissue coverage and mandibular restoration were successful in all patients, and flap survi val was 100%. Five of the seven patients (70%) achieved good or excell ent functional results, and five of seven (70%) achieved good or excel lent esthetic results. Complications were minimal, and the average hos pital stay was 14 days, Conclusions: When the initial attempt at mandi bular reconstruction is unsuccessful, mandibular function and esthetic s can be salvaged with reliable vascularized soft tissue and bone flap s. As long as appropriate flap options are considered and the patient is medically stable, successful mandibular reconstruction should be ac hievable despite the number or cause of prior failed attempts.