Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer.
BACKGROUND
The management of composite oromandibular defects involving the posterolateral mandible and surrounding soft tissue remains a reconstructive challenge. Although bony reconstitution restores continuity of the mandible, osteocutaneous flaps sometimes do not provide adequate soft-tissue coverage of these postablative defects. The purpose of this study was to evaluate the use of soft-tissue flaps for extensive posterolateral oromandibular defects.


METHODS
Consecutive patients who underwent reconstruction of composite oromandibular defects following posterolateral mandibulectomy between 1992 and 2006 were identified. Patient data were obtained from a prospectively maintained clinical database. Medical records were reviewed to characterize the extent of all postablative soft-tissue defects. Soft-tissue resection zones were defined as those involving the external cheek skin and/or lips, intraoral lining, tongue, retromolar trigone, palate, pharynx, and/or esophagus.


RESULTS
In total, 76 patients were identified as having extensive posterolateral oromandibular defects reconstructed with soft-tissue flaps alone. In 62 percent of patients who underwent nonosseous free-tissue transfer, the oromandibular defect involved two or more soft-tissue zones. The most common flap used was the vertical rectus myocutaneous flap (n = 68). At the time of discharge, 54 percent of patients were on an oral diet. Sixty percent of patients had intelligible speech. Overall aesthetic outcome was good in 49 percent, fair in 21 percent, and poor in 30 percent of patients.


CONCLUSIONS
Extensive composite defects of the posterolateral mandibular can be repaired effectively using soft-tissue flaps alone. When reconstructing a defect involving (1) the posterolateral mandible, overlying soft-tissues, and external skin and/or (2) the posterolateral mandible and two or more adjacent soft-tissue zones, the use of a soft-tissue flap alone can maximize success.
Mosahebi
Afshin
A
London, United Kingdom; and New York, N.Y. From the Department of Plastic Surgery, Royal Free Hospital, and the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
Chaudhry
Arif
A
McCarthy
Colleen M
CM
Disa
Joseph J
JJ
Mehrara
Babak J
BJ
Pusic
Andrea L
AL
Hu
Qunying
Q
Cordeiro
Peter G
PG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003679:Deglutition; D005260:Female; D005360:Fibula; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D009062:Mouth Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis; D012189:Retrospective Studies; D013060:Speech; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult