OROMANDIBULAR RECONSTRUCTION WITH THE FIBULAR FREE-FLAP - ANALYSIS OF50 CONSECUTIVE FLAPS

Objective: To evaluate the results and functional outcome associated w ith fibular free flap reconstruction of orofacial and mandibular defec ts. Design: We conducted a retrospective analysis of 50 consecutive fi bular free flaps during a 3-year period. Forty patients were available for follow-up, which ranged from 4 to 39 months. Setting: Academic te rtiary care referral medical center. Patients: Fifty consecutive mandi bular reconstructions using the fibular free flap were performed on 47 patients. Thirty-five;patients (74%) underwent primary reconstruction . Sixty-six percent of the mandibular defects were anterior or combine d anterolateral types; the remainder were pure lateral defects. In 38 patients (81%), a skin paddle was included with the flap to provide ei ther a mucosal lining or skin cover, whereas in only 9 patients (19%), bone was used alone. Main Outcome Measures: Factors reflecting functi onal properties and processes as well as complications of the upper ae rodigestive tract were evaluated clinically and radiographically. Resu lts: Four flaps required reexploration as emergencies, and none were s uccessfully salvaged (8.5% failure). Three patients underwent further free vascularized fibula transfer with 1 failure. During follow-up, sw allowing was normal in 25 patients (64%), oral continence was normal o r almost normal in 26 patients (67%), and speech was normal or easily intelligible in 35 patients (90%). Aesthetic results were excellent or acceptable in 37 patients (95%). Conclusions: Our results reveal that the vascularized fibular free flap is very suitable with an excellent success rate for reconstructing both the composite or simple long-spa nned mandibular defect. The overlying skin island is reliable and prov ides lining or coverage for intraoral and extraoral defects. Superior functional and cosmetic results are expected in the majority of patien ts, while donor site morbidity is minimal.