Comparison between free osteocutaneous flap and free soft tissue flap in mandibular reconstruction

Abstract

Free vascularized fibular graft (FVFG) is the first choice for mandibular reconstruction after segmental/subtotal mandibulectomy. For patients with poor general condition or high tumor prognosis, however, we use free soft tissue flaps with/without a reconstruction plate (RP). In this article, we compare these procedures in terms of complication rate and postoperative function.
From September 2002 to December 2008, 47 patients underwent immediate mandibular reconstruction with free flaps in our hospital. Free vascularized osteocutaneous flaps were used in 26 patients (fibula in 22, scapula in 4), free myocutaneous/cutaneous flaps without RP in 16 (RAMC in 13, ALT in 3), and free myocutaneous flaps with RP in 5 (RAMC in 5).
Postoperative complications such as wound infections and fistulas were observed in 34%, 44%, and 80%, and a normal diet was possible in 86%, 63%, and 0% of the patients, respectively.
Based on these results, we believe that free soft tissue flaps without bone or plate could be an option for mandibular reconstruction for patients with poor general condition or high tumor prognosis.