Oromandibular Reconstruction Using Microvascular Composite Flaps

Abstract

MICROVASCULAR techniques to transfer vascularized bone to the head and neck region have been successfully applied to the problem of segmental mandibular defects. The use of these techniques for reconstruction is particularly well suited to the hazards of performing primary osseous reconstruction in the oral cavity, and its reliability has clearly surpassed that of the myriad other techniques that have been proposed for this purpose.¹ The many reports of the use of microvascular osseous mandible reconstruction that have been published from a variety of centers lend credence to the statement that primary oromandibular reconstruction with vascularized bone-containing free flaps (VBFFs) has become the standard of care. Moreover, this procedure should be offered to all patients who are medically fit and who are undergoing segmental mandibulectomies for the treatment of benign or malignant neoplasms, and for the management of stage III osteoradionecrosis (radiation-induced osteomyelitis).^2-4 The advantages of this method are that it allows the transfer of bone and soft tissue with a rich vascular supply that permits these tissues to withstand the detrimental effects of the normal oral flora and postoperative radiotherapy. Preserving the osteogenic potential of the transferred bone permits it to take an active role in osteosynthesis with the native mandible and to accept dental implants in the primary setting, thereby allowing complete oromandibular rehabilitation.