Reconstruction of mandible by free fibular flap.

Objective: To determine the results of using the free vascularized fibular flap for comprehensive reconstruction of postresection or post-traumatic mandibular defects.

Study Design: Case series.

Place And Duration Of Study: Department of Oral and Maxillofacial Surgery, King Edward Medical University, Lahore, from March 2007 to June 2009.

Methodology: The study group consisted of patients who underwent reconstruction of continuity defects of the mandible using a fibular vascularized free flap. Indication for mandibular resection were squamous cell carcinoma of the floor of the mouth and alveolar ridge in 5 cases, ameloblastome of the mandible in 6 cases, odontogenic keratocyst in 3 cases, defect due to fire arm injury in 2 cases and central giant cell granuloma of the mandible in one case. The type of reconstruction performed was primary reconstruction in 11 patients and secondary in 6 patients.

Results: There were 17 patients including 14 males and 3 females with mean age of 40 years. All flaps except three survived. One patient died due to complications related to blood transfusion. Of those, 2 completely failed, one due to the unfavourable recipient bed of the patient with fire arm injury and other due to venous thrombosis. Donor site morbidity was low; there was some compromise in the ankle function but none of the patient complaint of foot drop. Simple problems with wound healing such as dehiscence and delayed wound healing developed in 5 patients, which usually required only local antiseptic treatment. After the operation patient began oral feeding and walking with some aid in fourth week and became completely ambulant in 8 weeks.

Conclusion: In this small series the free fibula flap was a versatile and reliable option for microvascular reconstruction of large mandibular defects. It provided a large quantity of bone, which could be easily shaped and passively adapt to the remaining mandible and for an implant-based prosthetic restoration.