Oromandibular reconstruction with vascularized free flaps: A review of 50 cases

Abstract

Fifty cases of oromandibular reconstruction using vascularized free flaps to evaluate functional parameters of results were evaluated. There were 23 iliac crest flaps, 17 fibula flaps, 30 ulnar forearm flaps, and 3 radial forearm flaps with bone. Thirteen female and 37 male patients comprised the study, with a mean age of 57.66 years. Squamous-cell carcinoma (SCC) constituted 86% of cases, of which 60% were T4 lesions and 13.9% were recurrent. Anterolateral mandibular defects constituted 48.7%, and the mean bone gap was 8.13 cm. Functional evaluation was based on the University of Washington Questionnaire (UWQ) through phone calls and personal communication. The mean hospital stay was 12.42 days. The external carotid (75%) and facial (18.3%) were the main recipient arteries. The internal jugular (47.05%) was the main recipient vein. Overall flap survival was 95.9%. Three flaps were lost due to unsalvageable venous thrombosis. Major local complications such as partial flap loss, hematoma, and orocervical fistula constituted 10% of cases. Speech was classified as "excellent" and "good" in 43.3% of cases. Swallowing was identified as "excellent" and "good" in 53.3% of cases. Cosmetic acceptance was rated "good" in 63.3% of cases. Vascularized free flap reconstruction of oromandibular defects provides excellent functional and aesthetic results. The majority of patients are able to tolerate a regular diet. Intelligible speech and acceptable appearance are restored, providing patient satisfaction.

Current role of the iliac crest flap in mandibular reconstruction

“…If the circulation is questionable, combined use of another skin flap is strongly recommended. 15,23 The main limitation of this study was its small sample size. It is not possible to draw any firm conclusions from a series of only 18 patients in 13 years.…”

“…7,[13][14][15] In addition to the scarcity of skin perforators from the deep circumflex iliac vessels, geometric problems in flap insetting play a detrimental role in oromandibular reconstruction. 16 When used for intraoral lining, the skin island of the iliac crest flap should be rotated around the undersurface of the neomandible, because the skin island naturally lies on the external surface.…”

Microvascular Free Flaps in Oral and Maxillofacial Reconstruction following Cancer Ablation

“…40 The iliac crest has been criticized because of the poor reliability of the skin paddle and because osteotomies of the donor graft have been shown to decrease the viability of the bone graft. 41 The decreased viability of the skin paddle has been proposed to be a geometric problem, as the skin island naturally lies on the external surface of the graft, but must be rotated underneath the neomandible to form neworal lining which interferes with perfusion and complicates the task of obliterating dead space in reconstruction. The variability of perforator artery anatomy may also contribute to the unreliability of the skin paddle in reconstruction.…”

“…At present, the day has dawned in which MFFs are considered as the workhorse and the standard of care for reconstructing large ablative defects of this complex anatomic region. 3 This article reviews most commonly used MFF to explain their growing impact on OMF reconstructive surgery.…”

18 Reconstruction of the Mandible

“…[7][8][9][10][11][12][13][14] The primary advantages of this donor site include: available length of bone, associated soft tissues available, near anatomic dimension, ability to accept bicortical implants and relatively low donor site morbidity. The ability to harvest the flap concurrent with the resection procedure optimizes case flow and minimizes length of procedure.…”