Free Vascularized Flaps for Reconstruction of the Mandible: Complications, Success, and Dental Rehabilitation

Evolution of surgical techniques for mandibular reconstruction using free fibula flaps: The next generation

“…As with any new technology or technique, many were resistant to adopting it. Anecdotal and objective reports, though, have begun to swing the pendulum of opinion and the benefits of the technology have become increasingly accepted. This report provides examples of new and exciting innovations in functional and aesthetic mandibular reconstruction that would not be feasible without VSP.…”

Functional Outcomes of Virtually Planned Free Fibula Flap Reconstruction of the Mandible

“…Our overall and flap-specific complication rates, including flap loss, were high but consistent with previously published series and the overall morbidity of our cohort. 12,13 We investigated the impact of several disease-, patient-, and technique-specific variables on risk for complications. Of the variables investigated, only radiation therapy was found to be a significant risk factor.…”

“…13,24,25 When dental rehabilitation is defined as successful implantation resulting in denture placement, this number is even lower at 15 to 25 percent. 13,24,26 We were able to achieve these rehabilitation rates despite the fact that nearly half of our patients required ablation of malignant disease. In fact, we were able to achieve implant placement in five patients receiving radiation therapy for squamous cell carcinoma, with an acceptable complication rate.…”

Mandible Reconstruction

“…Metal plates and prosthetics require soft tissue coverage, but the combination has been associated with unacceptable rates of flap failure. 4 Pedicled trapezius and pectoralis osteomyocutaneous flaps often do not provide enough tissue. Iliac crest flaps have limited sculptability due to the bone's inherent shape.…”