Mandible reconstruction with a vascularized fibular graft (Review Article)

Abstract

Vascularized fibula graft (VFG) has been the most favored method for mandible reconstruction, because of the availability of long bone segments, pliable skin paddle, and possibility of multiple osteotomies. This report describes details of the surgical technique and clinical key points of VFG reconstruction.
The preoperative design of a VFG is placed at the ipsilateral leg with mandible bone defect, and a certain amount of the flexor hallcis longus muscle is harvested simultaneously as a usual surgical plan. The harvested flexor muscle is used to eliminate the dead space in the submandibular region after cervical lymphadenectomy.
Elevation of the VFG is carried out under avascularization with a tourniquet in the supine position, and skin paddle and bone segment of sufficient size are harvested. Osteotomy to reestablish the shape of the new mandible should be carried out at the donor leg after deflating the tourniquet. Care must be taken to keep the minimal length of the osteotomized bone segment larger than 2cm. After completion of shaping the bone graft, the VFG is taken from the donor leg and transferred to the cervical defect.
The transferred VFG is then fixed to the remnant mandible with a miniplate or mandible reconstruction plate and screws. The optimal occlusal plane must be obtained with temporary inter-maxillary fixation during the surgery. Vascular anastomosis between the pedicle of the flap and cervical vessels is carried out after bone fixation. Finally, the skin paddle of the VFG is sutured with intraoral mucosal defect, and the cervical skin is closed.