Choice of osseous and osteocutaneous flaps for mandibular reconstruction

Abstract

Microvascular free flap transfer currently represents one of the most popular methods for mandibular reconstruction. With the various free flap options now available, there is a general consensus that no single kind of osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either "lateral" or "anterior" and the soft-tissue defect is classified as "none," "skin or mucosal," or "through-and-through." For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is "lateral" and the soft tissue is not defective, the ilium is the best choice. When the bony defect is "lateral" and a small "skin or mucosal" soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is "lateral" and an extensive "skin or mucosal" or "through-and-through" soft-tissue defect exists, the scapula should be selected. When the bony defect is "anterior," the fibula should always be selected. However, when an "anterior" bone defect also displays an "extensive" or "through-and-through" soft-tissue defect, the fibula should be used with other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.

Computer-Assisted Mandibular Reconstruction with Monocortical DCIA Flap; A Case Report

“…In addition, the precise bone collection minimizes complication on the donor site as it leaves less donor site defects, and allows better results for the reconstructed mandible form and jaw relation (4). Mandibulectomy may cause problems in mastication, swallowing, and pronunciation and the reconstruction of these defects are surgically difficult (5). For a successful mandibular reconstruction, reconstruction with microanastomosis preferred by its satisfactory results in both functional and esthetic aspects (6).…”

Scapular free flap harvest site: recognising the spectrum of radiographic post-operative appearance

“…The scapular osteocutaneous flap, although first described in the 1980s [1,2], is increasingly used for reconstruction after head and neck surgery [3,4]. The flap offers several advantages, including ease of harvesting, an extensive and varied subscapular arterial and venous system (Figure 1a), up to 14 cm of bone, and a multitude of soft tissue as well as bone flaps (Figure 1b).…”

“…The option was initially used in patients with multiple surgeries whose traditional donor sites were already used. However, they are increasingly selected because they are ideally suited to repair defects of the lateral mandible that include skin, mucosal or "through-andthrough" soft-tissue loss [3]. When harvesting the bone, the lateral border and inferior angle can be harvested together or separately with independent blood supplies, based on the subscapular system [1,2].…”

Microvascular Free Flaps in Oral and Maxillofacial Reconstruction following Cancer Ablation

“…37 Proponents of the vascularized iliac crest free flap report several beneficial characteristics for mandibular reconstruction including the provision of good, sturdy bone with an intrinsic curvature that is useful in restoring hemi-mandibular defects. 38 Additionally, the cortical bone of the iliac crest allows for dental rehabilitation via osseointegrated dental implants.…”