The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: Comparison and long-term evaluation

Background. A variety of free flaps have been successfully used for mandibl e reconstruction. This study compared the short- and long-term results of u sing the free iliac crest and fibula flaps. Methods. We conducted a retrospective analysis of 117 patients who underwen t mandibular reconstruction, 59 patients with iliac crest and 58 with free fibula. Accurate long-term functional assessment was possible in 31 cases i n the iliac crest group and in 48 patients with fibular reconstruction. Ant erior or combined anterolateral defects formed 72% and 64% in the iliac cre st and fibula groups, respectively. The remainder were pure lateral defects . In both series, a skin paddle was included to provide either lining, skin cover, or both in 77% of the cases, whereas in 33% bone only was used. Results. Complications included two perioperative deaths and three flap los ses in the iliac crest group and five flap losses in the fibula group. Long -term functional and cosmetic assessment showed no statistically significan t differences in oral continence (p > 0.9), speech (p= 0.57), and contour r esults (p = 0.80) between the two groups. However, oral deglutition was sta tistically significantly better in the fibula free flap group (p= 0.009). Conclusion. Although the fibula free flap is the flap of choice, the iliac crest is an excellent and reliable complementary flap for mandibular recons truction. (C) 1999 John Wiley & Sons, Inc.