Mandibular reconstruction with free vascularized fibular flap.

Although various sources of vascularized bone/composite tissue have been used for mandibular reconstruction, the vascularized fibular flap has been reported to have many advantages over the others and to be the most suitable for bridging a long-span mandibular defect. In this paper, positive experience of 14 consecutive cases in which a free vascularized fibular graft with or without a skin paddle has been used to reconstruct a long mandibular defect is reported. Half of the cases were primarily reconstructed, the rest secondarily. The average length of the fibula graft harvested was 16.7 cm, with a range of 12 to 22 cm. The number of wedge osteotomies ranged from 0 to 4, with an average of 1.67. In ten flaps, a peroneal skin paddle was included. The donor wound was typically closed directly, except in three cases, where a skin graft was used. Vein grafts were performed in five cases to lengthen the pedicle. In two cases, the skin partially necrosed. All scintigrams except one showed good bone viability. But there was no total flap failure. Postoperative facial appearances were fair to excellent, with mouth opening ranging from 21 to 50 mm. Although unusual serious donor wound rupture was experienced in one case, in general the donor site complications were minimal.