The free fibula bone graft for salvaging failed mandibular reconstructions.
OBJECTIVE
The purpose of this study was to determine the efficacy of vascularized free fibula bone grafts for mandibular salvage reconstruction.


METHODS
Seven patients had fibula grafts after failed attempts at mandibular reconstruction. The prior attempts involved 20 operative procedures. Four of the seven patients (57%) had a history of radiation to the affected mandible. Bony defects averaged 10.2 cm (range, 4.5 to 24 cm), and the associated soft tissue defects averaged 6 x 12 cm. Average follow-up was 16 months. Cosmetic (facial symmetry) and functional (speech quality, oral continence, deglutition, donor site morbidity, dental rehabilitation) results were evaluated by questionnaire and clinical examinations.


RESULTS
Soft tissue coverage and mandibular restoration were successful in all patients, and flap survival was 100%. Five of the seven patients (70%) achieved good or excellent functional results, and five of seven (70%) achieved good or excellent esthetic results. Complications were minimal, and the average hospital stay was 14 days.


CONCLUSIONS
When the initial attempt at mandibular reconstruction is unsuccessful, mandibular function and esthetics can be salvaged with reliable vascularized soft tissue and bone flaps. As long as appropriate flap options are considered and the patient is medically stable, successful mandibular reconstruction should be achievable despite the number or cause of prior failed attempts.
Anthony
J P
JP
Division of Plastic and Reconstructive Surgery, University of California at San Francisco 94115-1632, USA.
Foster
R D
RD
Pogrel
M A
MA
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D003679:Deglutition / Q000502:physiology; D017266:Dental Prosthesis; D004954:Esthetics; D005145:Face; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000601:surgery; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000528:radiation effects / Q000601:surgery*; D008336:Mandibular Diseases / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000502:physiology; D010025:Osteoradionecrosis / Q000601:surgery; D015203:Reproducibility of Results; D016879:Salvage Therapy; D013060:Speech / Q000502:physiology; D013524:Surgical Flaps / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery