Immediate reconstruction of the mandible using a vascularized segment of radius

Abstract

Resection of a segment of mandible, particularly when associated with malignant disease, carries a high morbidity and mortality. Traditional methods of autogenous bone grafting have proved unreliable in immediate reconstruction of such mandibular defects because of the variability of the recipient bed. These unfavorable conditions for bone graft survival can be largely overcome using vascularized bone and vascularized soft tissue reconstruction. The radial forearm free flap has proved a versatile and useful method in intraoral reconstruction and can be used together with a segment of radius as a composite flap. The technique of raising a segment of vascularized radius is described and its use in immediate reconstruction of the mandible at the time of resection illustrated in a series of 14 consecutive cases. There was one microvascular failure in this series and one postoperative death. The remaining 12 cases have had a successful outcome and show clinical union in the follow‐up period varying from 11‐36 months. There is evidence indicating that the bone maintains its viability even in the presence of preoperative or early postoperative radiotherapy.

A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical results

“…In many cases these composite flaps can be harvested from one donor site and the reconstruction can be carried out with a composite flap perfused by one vascular pedicle. If defects of the mandible have to be covered, microvascular fibula 18 , iliac crest 10,22 , scapula 19 , rib 3,16 or radius flaps 20 are used most often 24 . These flaps may be used as osseous, osteocutaneous or osteomyocutaneous transplants to make individual tissue transfer possible, depending on the components to be reconstructed.…”

Choice of osseous and osteocutaneous flaps for mandibular reconstruction

“…Osseous flaps for mandibular reconstruction have been widely developed from the rib, 26-28 metatarsus, 29-31 ilium, 32-34 scapula, 35-37 fibula 38-40 and radius. [41][42][43] Along with vascularized bone flaps, free soft-tissue flaps have also played an important role in the progress of mandibular reconstruction by reviving the use of biomaterials. According to Hamaker,19 Martin was the first to reform the mandibular arch with an external prosthetic appliance, in 1889.…”

Microvascular Free Flaps in Oral and Maxillofacial Reconstruction following Cancer Ablation

“…It is versatile in that it also may be transferred as a sensory flap incorporating the medial or lateral antebrachial cutaneous nerve, 8,9 or a composite bone flap using vascularized radius. [10][11][12] It also may include vascularized tendon 13 and brachioradialis muscle. 14 The major disadvantages of RFFF is the donor site morbidity especially in cases of paratendon damage during flap harvest causing tenting and painful donor site which can be reduced by suprafascial dissection and minimizing paratenton exposure.…”