Abstract
Seventy-four cases of mandibular reconstruction using vascularized bone grafts—44 fibular flaps, 23 scapular flaps and 7 iliac crest flaps—were studied. The numbers of diseases treated by mandibular reconstruction were classified as: 42 patients with malignant disease, 15 with benign tumor, 13 with osteoradionecrosis, and 4 with other diseases. Of these cases, 35 patients simultaneously underwent reconstructive surgery following mandibulectomy, and the remaining 39 patients underwent secondary mandibular reconstruction after mandibulectomy. The graft survival rate of fibular flaps was 88.6%, and those of the other two flaps were 100%. Iliac crest flaps are suitable bone if reconstruction is indicated for defect type A and body in the CAT classification. Scapular flaps are used for relatively diverse types of defect in the CAT classification. On the other hand, fibular flaps are used for a much wider range of mandibular defects than scapular flaps, and for very small defect types. The choice between scapular flaps and fibular flaps depends not only on the type of mandibular defect, but also on a strategy for cancer treatment and on the proficiency of the surgeon in using the specified flap.
