Reconstruction of Extensive Composite Posterolateral Mandibular Defects Using Nonosseous Free Tissue Transfer

Abstract

Extensive composite defects of the posterolateral mandibular can be repaired effectively using soft-tissue flaps alone. When reconstructing a defect involving (1) the posterolateral mandible, overlying soft-tissues, and external skin and/or (2) the posterolateral mandible and two or more adjacent soft-tissue zones, the use of a soft-tissue flap alone can maximize success.

Skull Base Reconstruction

“…Good results with soft-tissue reconstruction alone can be achieved for posterior mandibular defects. 14,15 Reconstructions for combined regions II and III are similar but need to extend further posteriorly to the region of the temporal bone (Fig. 6).…”

Double free flap reconstruction of through-and-through oromandibulofacial defects

“…In our series of 80 single soft tissue free flaps + plate reconstruction, persistent plate exposure occurred in 44% with the need for revisional surgery in the form of second free flap required in over half of these cases [14]. One alternative that may obviate the risk of plate exposure, but at the expense of mandibular integrity, is the use of a single flap without mandibular reconstruction with bone or plate [12]. This may be reasonable option in poor prognosis patients but is less acceptable in primary tumours with a good prognosis, for whom quality of life is partially dependent on adequate restoration of speech and swallowing.…”

“…Perioperative mortality was reported in only our 1999 series with one perioperative death in 36 cases (2.8%), and only two other perioperative deaths have been reported in the literature (1.2% overall perioperative mortality). This is comparative to other forms of reconstruction for composite defects, with reported mortality rates of 4% for single soft tissue flaps [12] and 7% for pedicled pectoralis major-free fibula flap combinations [5]. Furthermore, although there are no direct comparative studies in the literature regarding complication rates of double free flaps versus other forms of reconstruction such as pedicled pectoralis major-fibula flap combinations-the complication rates and operative time of double free flap surgery have not been reported as significantly higher [5].…”

“…Despite the perceived advantages of double free flaps in terms of restoration of like-for-like tissues and versatility in inset and of deadspace obliteration, not all consider this the optimal approach, with a number of key criticisms raised [12,18].…”

“…These alternative techniques may be viewed by others as safer or quicker options [12]. Additionally, functional and aesthetic outcomes of double free flaps have not been adequately compared with other techniques [17,18].…”