+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases



Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases



Plastic and Reconstructive Surgery 108(6): 1555-1563



For this article, 178 consecutive cases of mandibular reconstruction using microvascular free flaps and performed from 1979 to 1997 were studied. The purpose of this report is to compare flap success rates, complications, and aesthetic and functional results. The ages of the 131 men and 47 women ranged from 13 to 85 years, with an average of 55 years. Donor sites included the rib (11 cases), radius (one case), ilium (36 cases), scapula (51 cases), fibula (34 cases), and soft-tissue flaps with implant (45 cases). Complications included total flap necrosis, partial flap necrosis, major fistula formation, and minor fistula formation. The rate of total flap necrosis involving the ilium and fibula was significantly higher than that of all other materials combined (p < 0.05). The overall rate of implant plate removal, which resulted from the exposure or fracture of the plate, was 35.6 percent (16 of 45 cases). Each mandibular defect was classified by the extent of the bony defect and by the extent of the soft-tissue defect. The extent of the mandibular bony defect was classified according to the HCL method of Jewer et al. The extent of the soft-tissue defect was classified into four groups: none, skin, mucosal, and through-and-through. According to these classifications, functional and aesthetic assessments of deglutition and contour were performed on 115 subjects, and speech was evaluated in 110. To evaluate the postoperative results, points were assigned to each assessment of deglutition, speech, and mandibular contour. Statistical analysis between pairs of bone-defect groups revealed that there was no significant difference in each category. Regarding deglutition, statistical analysis between pairs of soft-tissue-defect groups revealed there were significant differences (p < 0.05) between the none and the mucosal groups and also between the none and the through-and-through groups. Regarding speech, there was a significant difference (p < 0.05) between the none and the through-and-through groups. Regarding contour, there were significant differences (p < 0.01) between the none and the through-and-through groups and between the mucosal and the through-and-through groups. The points given for each function, depending on the reconstruction material, revealed that there was no significant difference between pairs of material groups. From this prospective study, the authors have developed an algorithm for oromandibular reconstruction. When the bony defect is lateral, the ilium, fibula, or scapula should be chosen as the donor site, depending on the extent of the soft-tissue defect. When the bony defect is anterior, the fibula is always the best choice. When the soft-tissue defect is extensive or through-and-through with an anterior bony defect, the fibula should be used with other soft-tissue flaps.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 046619939

Download citation: RISBibTeXText

PMID: 11711927

DOI: 10.1097/00006534-200111000-00018


Related references

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta-analysis. Microsurgery 35(7): 576-587, 2015

Analysis of microvascular free flaps for reconstruction of advanced mandibular osteoradionecrosis: a retrospective cohort study. Journal of Oral and Maxillofacial Surgery 66(12): 2545-2556, 2008

Rhytidectomy approach for mandibular reconstruction with microvascular free flaps after resection of mandibular benign tumors. Journal of Oral and Maxillofacial Surgery 71(12): 2156-2168, 2013

A Comparison of Bone Resorption Over Time: An Analysis of the Free Scapular, Iliac Crest, and Fibular Microvascular Flaps in Mandibular Reconstruction. Journal of Oral and Maxillofacial Surgery 75(3): 616-621, 2017

Microvascular free flaps for mandibular reconstruction in Goldenhar syndrome. Journal of Craniofacial Surgery 22(3): 1161-1163, 2011

Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 108(4): 488-495, 2009

Mandibular reconstruction with microvascular re-anastomosed fibular free flaps - two complementary methods of postoperative transplant monitoring. Clinical Hemorheology and Microcirculation 52(2-4): 141-151, 2012

Reconstruction of Congenital Mandibular Hypoplasia With Microvascular Free Fibula Flaps in the Pediatric Population: A Paradigm Shift. Journal of Craniofacial Surgery 28(1): 79-83, 2017

Reconstruction of Congenital Mandibular Hypoplasia with Microvascular Free Fibula Flaps in the Pediatric Population: A Paradigm Shift. Plastic and Reconstructive Surgery 136(4 Suppl.): 45-46, 2015

Reconstruction of the Achilles tendon region by free microvascular flaps. 9 cases followed for 1-9 years. Acta Orthopaedica Scandinavica 63(5): 482-486, 1992

Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. Journal of Trauma 29(8): 1086-1094, 1989

Microvascular free flaps in head and neck reconstruction: Report of 200 cases and review of complications. Archives of Otolaryngology Head and Neck Surgery 120(6): 633-640, 1994

Technical refinements in mandibular reconstruction with free fibula flaps: outcome-oriented retrospective review of 99 cases. Acta Otorhinolaryngologica Italica 34(5): 342-348, 2014

Revascularized free scapular flaps in mandibular reconstruction. Report of 93 cases (April 1997 - October 2009). Revue de Laryngologie - Otologie - Rhinologie 131(4-5): 263-268, 2010

A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps. Journal of Plastic Surgery and Hand Surgery 49(2): 95, 2015