Mandibular Reconstruction with Vascularized Osseous Free Flaps: a Review of the Literature

Abstract

Purpose: This article reviews a few of the commonly used types of vascularized osseous free flaps in maxillofacial reconstruction, which still represents the gold standard of restoration. We also discuss the developing concepts in maxillofacial reconstruction. Recent findings: Most of the literature reconfirms the established patterns of reconstruction with the aid of vascularized osseous free flaps. This method of freetissue transfer is also feasible in cases of osteoradionecrosis or bisphosphonate-related osteonecrosis of the jaw. These flaps are also suitable for prosthetic restoration using osseointegrated dental implants. Summary: Vascularized osseous free flaps still remain the standard of care. Improvements upon the free-tissue transfer method employing vascularized osseous free flaps, such as distraction osteogenesis, tissue engineering, and imaging techniques, currently require further development, but these technologies could lead to improved outcomes of maxillofacial reconstruction in the near future.

Sectioned Images and Surface Models of a Cadaver for Understanding the Deep Circumflex Iliac Artery Flap

“…4,5 It provides sufficient length of a thick, strong, and tall bone, which is of adequate stock to support an osteointegrated dental implant, all the while maintaining the right shape for the hemimandible. 1 Despite these features, the flap remains an unpopular choice for the reconstruction of oromandibular defects, because of the higher risk of donor-site morbidity (ie, abdominal hernia) and the relatively difficult flap-harvesting technique. 1 For this reason, it is beneficial to accumulate a good foundation of anatomical knowledge related to the DCIA flap.…”

“…4Y6 In this procedure, a strong, thick, and tall bone of proper stock and sufficient length is used to support an osteointegrated implant, so as to reasonably match the contour and shape of the mandible. 7 However, because of its anatomical approach being considerably more difficult than that for other flaps, and the high risk of donor-site morbidity (ie, abdominal hernia), the DCIA flap is a less popular choice for composite mandibular reconstructions 1,7 Therefore, it is helpful to understand the anatomy associated with the DCIA flap.…”

“…1 The positioning of the oromandibular area makes it a highly visible one, and therefore, during reconstruction and tissue coverage, much emphasis is placed on imitating the resected native tissue to gain superior aesthetic and functional results. 1 At present, vascularized osseous free flaps are the most feasible option for reconstruction of oromandibular defects, especially those greater than 5 cm in diameter. 2,3 The deep circumflex iliac artery (DCIA) flap is a useful option for the reconstruction of the mandible.…”

Sectioned images and surface models of a cadaver for understanding the free vascularised anterior rib flap

“…Mandibular reconstruction should aim at replacing both function and form [8]. Speech, appearance, and mastication should be considered during surgical planning.…”

“…The position of the mandible is highly perceptible. Therefore, during reconstruction and tissue coverage, reproduction of the resected native tissue is critical to acquire better functional and aesthetic results [8]. However, these aims are difficult to accomplish when it comes to defects of the mandibular condyle.…”