Comparison of reconstructive procedures in primary versus secondary mandibular reconstruction

Abstract

Success in secondary mandibular reconstruction could be achieved utilizing a range of osseous free flaps, and there was no increased rate of complications compared with primary mandibular reconstructions.

Functional outcomes following secondary free flap reconstruction of the head and neck

“…However, Andrade et al showed no change in complication rate comparing 39 secondarily reconstructed mandibles (49% for fistulae or exposed hardware) to 110 primary reconstructions. 7 Osteocutaneous flaps in this series had longer operative times and more frequent tracheostomy on discharge, but with a lower fistula rate than soft tissue flaps. The higher rate of delayed decannulation may be due to the soft tissue bulk of skin paddles associated with the fibula free flap or edema due to the lengthy operative time.…”

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

“…On the other hand, there were only five papers (99,114,154,180,183) in which the type of flap could not be related to non-union.…”

“…The four main flap donor sites were the fibula with 6178 flaps (8, 12, 16-18, 20-22, 24, 26-28, 32-55, 57-59, 61-64, 66-, 79, 81-83, 85, 87-89, 93, 94, 96-104, 106, 108 -131, 131, 133, 135, 137-141, 143, 145-154, 156, 158-169, 171-175, 179-184, 186-193, 195, 196, 198-200, 202-207, 209, 210, 212-216, 218-223, and 225-229), the iliac crest with 1380 flaps (8, 12-15, 17-20, 26, 29,31, 36, 38, 41, 45, 48, 50, 53, 54, 57-60, 62, 63, 65, 67, 72, 74, 75, 77, 79, 83, 84, 86, 87, 92, 96, 98, 99, 102, 105, 112-115, 121, 132, 149, 151, 152, 155, 157, 158, 161, 168, 170, 171, 173, 174, 177, 178, 181, 183, 186, 201, 211, 212, 216, 219, 227), composite radius with 1127 flaps (8, 10-12, 17, 20, 23, 25, 30, 32, 33, 48, 50, 56, 62, 67, 72, 75, 77, 80, 85, 87, 91, 93, 95, 96, 98, 99, 104, 113, 114, 133, 150, 152 154, 165, 176, 180, 183, 185, 203, 213, and scapula with 709 flaps (8,9,12,14,17,26,32,45,46,48,50,53,58,59,63,67,70,74,77,85,87,90,93,96,99,113,114,134,136,142,144,151,156,169,172,189,191,194,…”

Tailored approach to oromandibular reconstruction in patients with compromised lower limb vessels

“…However, the widespread availability of magnetic resonance angiography (MRA), which provides highly detailed information on the lower limb vasculature without the morbidity of conventional angiography, has resulted in it being routinely adopted in many centers . In cases in which the imaging is not favorable and fibula flap harvest is inadvisable, osseous reconstruction of the mandible can still be achieved using an alternative donor site . In practice, the choice depends on the experience and preference of the surgeon.…”

“…In practice, the choice depends on the experience and preference of the surgeon. When other composite free flaps are deemed inappropriate or are not within the skillset of the reconstructive surgeon, soft tissue reconstruction of the mandible has been reported . This is associated with a less satisfactory aesthetic and functional outcome .…”