O-081. Secondary oro-mandibular reconstruction with composite free flaps

Aims: Patients presenting for secondary oro-mandibular reconstruction have a unique set of problems; these include the presence of soft tissue contracture that displaces the mandibular segments in malposition and soft tissue deficiencies, making surgical correction more difficult and potentially more hazardous. Vascularized bone-containing free-flaps are indicated in secondary oro-mandibular reconstruction where both hard and soft tissues replacement is needed or when the recipient bed is unfavorable due to previous surgery and/or radiation. Methods: The authors present their experience with 30 cases of secondary oro-mandibular reconstruction treated in the period from September 1995 to September 2000, using bone containing free flaps. Two different donor sites were used to harvest bone-containing free flaps: iliac crest in 12 cases and fibula in the others. In nine cases the flap was only osseous, in four cases osteomuscular (iliac crest free flap) and in the other cases osteocutaneous. Result: Total flap necrosis occurred only in one case of iliac crest free flap for venous thrombosis; in two cases necrosis of the skin component of the flap was observed. In two radiated patients we observed perforation of the skin by the reconstruction plate and in three patients intraoral dehiscence occurred. Conclusion: The introduction of vascularized bone containing free flaps transferred from distant sites by microvascular techniques has revolutionized mandibular reconstruction. Vascularized bone transferred into tissue beds compromised by salivary contamination and previous irradiation and the rational use of the soft tissue components of the flap permit also the restoration of articulation, deglutition and mastication with quality of life better than nonvascularized alternatives.