The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects

Background. Ablation of large intraoral cancers can create extensive throug h-and-through defects of the lateral face. resulting in loss of external fa cial skin, the lateral and anterior mandible. and the lateral mouth. Repair requires reconstruction of the lips. mandible, and full-thickness cheek de fects. Ideal reconstruction with vascularized composite free flaps requires adequate bone and sufficiently large, yet versatile, skin flaps capable of resurfacing extensive intraoral and external defects. Methods. A series of 12 patients with large lateral facial-mandibular detec ts is reviewed. All patients were treated for squamous cell carcinoma excep t for 1 patient with osteoblastic sarcoma of the mandible. All patients und erwent primary reconstruction with various free flap techniques, including 6 scapular free flaps, 2 iliac crest free flaps, 3 free fibula flaps, and 1 radial forearm flap. Attainment of reconstructive goals, free flap surviva l. and complication rates were assessed. Results. All defects were successfully reconstructed in the primary setting . No flap failures occurred. One venous occlusion was successfully salvaged . No orocutaneous fistulas or postoperative hematomas were noted. Conclusion. The reconstructive options for extensive defects of the lateral face and jaw are reviewed with attention to the complex three-dimensional soft tissue requirements. The superiority of the scapular composite flap is emphasized because this single free flap provides two independent and vers atile skin paddles of optimal thickness in addition to adequate bone stock. (C) 2000 John Wiley & Sons, Inc.