Free bone flaps in esthetic and functional rehabilitation after segmental mandibulectomy. Apropos of 38 cases

Development of microvascular free tissue transfers gives the surgeon the opportunity to realise complex reconstructions after segmental mandibular resections for tumor. We reviewed 38 cases of oromandibular reconstruction using various free bone grafts (25 fibula, 7 scapular, 3 iliac and 3 forearm free flaps). The mandibular defect was anterior in 24 cases, lateral in 9 cases and subtotal in 5 cases. In the post-operative course there were two total flap losses. Long-term esthetic results were excellent or good for 82% of the patients, 81% were able to eat a solid or a soft diet. The causes of esthetic or functional failures were studied as well as the specific interest of each donor site. The use of free bone flaps improved cosmetic and functional rehabilitation in cases of anterior mandibular defects. The secondary reconstructions or reconstructions of lateral bony defects were more disappointing. The free fibula flap allows reconstruction of wide bony defects. Scapular flap or forearm flap are indicated for smaller bony defects and in patients with severe peripheral vascular disease.