The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation.
BACKGROUND
A variety of free flaps have been successfully used for mandible reconstruction. This study compared the short- and long-term results of using the free iliac crest and fibula flaps.


METHODS
We conducted a retrospective analysis of 117 patients who underwent mandibular reconstruction, 59 patients with iliac crest and 58 with free fibula. Accurate long-term functional assessment was possible in 31 cases in the iliac crest group and in 48 patients with fibular reconstruction. Anterior or combined anterolateral defects formed 72% and 64% in the iliac crest and fibula groups, respectively. The remainder were pure lateral defects. In both series, a skin paddle was included to provide either lining, skin cover, or both in 77% of the cases, whereas in 23% bone only was used.


RESULTS
Complications included two perioperative deaths and three flap losses in the iliac crest group and five flap losses in the fibula group. Long-term functional and cosmetic assessment showed no statistically significant differences in oral continence (p > 0.9), speech (p = 0.57), and contour results (p = 0.80) between the two groups. However, oral deglutition was statistically significantly better in the fibula free flap group (p = 0.009).


CONCLUSIONS
Although the fibula free flap is the flap of choice, the iliac crest is an excellent and reliable complementary flap for mandibular reconstruction.
Shpitzer
T
T
Division of Plastic Surgery, The Toronto Hospital, General Division EN 10-236, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Neligan
P C
PC
Gullane
P J
PJ
Boyd
B J
BJ
Gur
E
E
Rotstein
L E
LE
Brown
D H
DH
Irish
J C
JC
Freeman
J E
JE
D000328:Adult; D000368:Aged; D003679:Deglutition; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013065:Speech Intelligibility; D013524:Surgical Flaps; D016896:Treatment Outcome