Purpose: Mandibular reconstruction represents a challenge to the oral and m
axillofacial surgeon and has been revolutionized by the modem microvascular
techniques. Rehabilitation using techniques such as reconstruction plates
frequently produce a functional and cosmetic defect. The primary objective
of the current study was to evaluate the usefulness of the osteomuscular fr
ee fibular flap for this purpose.
Patients and Methods: The results of 26 vascularized free fibula flaps with
or without a skin paddle that were used for mandibular reconstruction is p
resented. The "double barrel" technique was used in 6 cases. The donor site
was closed directly in 2 cases and with an abdominal full-thickness skin g
raft in 24 cases.
Results: All flaps except 1 were viable. There was partial necrosis of the
skin island in 1 patient. The average length of the fibula graft was 10.96
cm, and the number of osteotomies ranged from 0 to 3. In the donor site, th
e most significant problem was unsatisfactory scarring related to the use o
f a skin graft. There were no long-term functional complications in the low
er leg. Two patients have been secondarily rehabilitated with osseointegrat
ed implants.
Conclusion: The fibula flap provides a successful bone graft for mandibular
restoration with an acceptably low complication rate. This method meets mo
st of the requirements for oral and mandibular replacement. (C) 2001 Americ
an Association of Oral and Maxillofacial Surgeons.