Composite free flaps in oromandibular reconstruction. Review of the literature.

The transfer of vascularized bone containing free flaps is the most effective method of achieving a functional oromandibular reconstruction in the primary setting. All of the reported series on mandibular reconstruction using microvascular free flaps, totaling 513 cases, are reviewed. The collective success rates of free flap transfers compiled from these series have steadily increased to 96% during the latter portion of this review. The experimental studies demonstrating the viability of vascularized bone following an ischemic insult are presented. The issues regarding primary and secondary mandible reconstruction are reviewed. Each of the eight donor sites for vascularized bone are discussed and rated with respect to the ideal qualities of the bone and soft-tissue components of a composite free flap to achieve an optimal oromandibular reconstruction.