MICROVASCULAR RECONSTRUCTION OF MANDIBLE BY FREE FIBULAR

Aim and Objectives: To determine the results of using the free vascularized fibular flap for comprehensive reconstruction of mandibular continuity defects. Materials and Methods: The study group consisted of patients who reported to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (R&R) from the year May 2010 to Mar 2014. underwent reconstruction of continuity defects of the mandible using a fibular vascularized free flap Indication for mandibular resection were squamous cell carcinoma of the floor of the mouth and alveolar ridge in 4 cases, ameloblastoma of the mandible in 8 cases, odontogenic keratocyst in 2 cases and 1 case of osteosarcoma of the mandible and 3 cases of patients with post traumatic mandibular defects sustained due to Gunshot wound (GSW) . The type of reconstruction performed was primary reconstruction in 12 patients and secondary in 6 patients. Results: There were 18 patients including 13 males and 5 females with mean age of 40 years. Of those, 2 completely failed, due to venous thrombosis. Donor site morbidity was low; there was some compromise in the ankle function but none of the patient complaint of foot drop. Simple problems with wound healing such as dehiscence and delayed wound healing developed in 3 patients, which usually required only local antiseptic treatment. After the operation patient began oral feeding and walking with some aid in fourth week and became completely ambulant in 8 weeks. Conclusion: In this small series the free fibula flap was a versatile and reliable option for microvascular reconstruction of large mandibular defects. It provided a large quantity of bone, which could be easily shaped and passively adapt to the remaining mandible and for an implant-based prosthetic restoration. S.K. Roy, Professor & Head, Dept of Oral and Maxillofacial Surgery Army Dental Centre (R&R), 2 Delhi Cantt-110010, Ajay P Desai, Assistant Professor, Dept of Oral and Maxillofacial Surgery 3 Army Dental Centre (R&R), Delhi Cantt-110010, P.K. Chattopadhyay, Associate Professor, Dept of Oral and Maxillofacial Surgery Army Dental Centre (R&R), Delhi Cantt-110010 V. Langer, Associate Professor, Dept of Plastic & Reconstructive Surgery, AH (R&R), 5 Delhi Cantt-110010, I.D. Roy, Associate Professor, Dept of Oral and Maxillofacial Surgery Army 6 Dental Centre (R&R), Delhi Cantt-110010, Col. Ravinder S. Semi, Assistant Professor, Dept of Oral and Maxillofacial Surgery Army Dental Centre (R&R), Delhi Cantt-110010 Col. Serat Rehman, Assistant Professor, Dept of Oral and Maxillofacial Surgery Army Dental Centre (R&R), Delhi Cantt-110010 INTRODUCTION : Mandibular reconstruction continues to be one of the most common surgical challenges faced by oral and maxillofacial surgeons. The advent of microvascular surgery has made it possible to reconstruct complex maxillofacial region in a single stage. This technique allows for larger resections and reconstruction, which allows patients to return to normal function in a much shorter period when compared with multistage local, regional pedicled flaps and nonvascularized free bone flaps [1]. Multiple studies have shown the clear superiority of microvascular reconstruction of the mandible when compared with ''traditional'' methods. Tissue loss resulting from cancer ablation, debridement of infected tissues or secondary to trauma provides the surgeon with various reconstructive challenges. Although reconstruction of soft tissue defects of head and neck requires a fasciocutaneous or musculocutaneous flap, composite tissue loss that includes bone should be managed with a flap that contains vascularized bone. The goal of reconstructive surgery in tissue loss is to repair the defect, early return to function with least complications [2]. Until the advent of free tissue transfer, reconstruction of the defects of mandible and midface was sub optimal. Plating across the defects with or without nonvascularized bone flaps usually results in plate exposure, particularly in irradiated patients. The fibula free flap provides a strong long segment of bone and can include a large fasciocutaneous component as well. As such this versatile flap may be harvested as an osteocutaneous flap or a purely osseous flap. It is now the most popular method of mandibular reconstruction. The free fibula flap provides a successful bone flap with an acceptably low complication rate [1, 2]. Fibular bone allows to plan osteotomies in relation to the orientation of the bone and its vascular pedicle. Thick cortical bone readily accepts plates and screws for a secure interosseous fixation and osteointegrated implants may be placed in this bone safely. Another advantage of the free fibular flap is that in case of the insufficient bone height for the prosthetic rehabilitation either a double barrel or distraction osteogenesis (DO) can be carried out [3]. Optimization of the height di? erential between the native mandible and the ? bula in selected patients may be achieved by placing the ? bula approximately 1 cm superior to the inferior border of the mandible [4]. Moreover, the free vascularized flaps are not MICROVASCULAR RECONSTRUCTION OF MANDIBLE BY FREE FIBULAR FLAP Journal of Dental Sciences University