AN EARLY EXPERIENCE OF MANDIBLE RECONSTRUCTION USING FREE FIBULA: OSSEOUS AND OSTEOCUTANEOUS FLAPS

Abstract

Objective: To evaluate the outcomes of using the free fibula, osseous and osteocutaneous flaps for reconstruction of mandibular defects resulting from trauma and after tumour resection.

Material and Methods: This descriptive study was conducted at the Plastic Surgery Unit, Hayatabad Medical Complex Peshawar and Plastic Surgery and Burn Unit, Khyber Teaching Hospital, Peshawar from January 2009 to July 2013. A total of 11 patients underwent reconstruction of mandible for defects either caused by trauma or after excision of malignant tumors. Fibula osseous or osteocutaneous flaps were used for the reconstruction of mandibular defects.

Results: There were 11 patients including 8 males and 3 females. The age of the patients ranged from 26-54 years and the mean age was 37 years. Indication for mandibular resection were squamous cell carcinoma of the floor of the mouth and alveolar ridge in 4 cases and central giant cell granuloma of the mandible in one case. All the 6 cases of trauma sustained firearm injuries that resulted in shattered mandible. Primary reconstruction of the mandibular defects was performed in all the patients. Nine of the flaps survived out of the total 11. Venous thrombosis was the cause of failure in the two flaps. In one patient partial necrosis of the skin paddle occurred. Partial wound dehiscence and delayed wound healing was observed in 4 patients. Apart from scarring at the dondor site, we observed ankle instability in 1 patient and residual pain in 3 patients and a temporay foot drop in one patient. The patients started oral feeding in the fourth week after operation and they were completely mobilised in 10 weeks’ time.

Conclusions: Fibula Free Flap is a reliable and adaptable choice for mandible reconstruction with relatively low donor site morbidity and good long-term outcomes.