Use of fibula free flap in mandible reconstruction: Cases reports (L’impiego del perone vascolarizzato nella ricostruzione della mandibola: presentazione dei casi clinici)

From January 1990 to December 1991, 4 patients were treated by the authors with fibula free flap for mandible reconstruction. Two cases were oncological, 1 posttraumatic and 1 infected pseudoarthrosis. The age of the patients ranged from 25 to 54, the average lenght of the mandible defect was 12.25 cm. In 1 case the anterior arch of the mandible was reconstructed and in the other 3 cases the reconstruction involved the hemimandible including the T-M joint (1 case). No early general, local or microsurgical complications were observed. We had only 1 late complication due to the recurrence of the infection in a case of recurrent infected pseudoarthrosis. Bone fixation was obtained with K. wires (2 cases) and with miniplates (2 cases). In 1 case together with the bone flap a fair amount of F.A.L. muscle was taken to better contour the soft tissue loss. All microsurgical anastomoses were performed on the facial artery and homonymous veins. All osteotomies sites healed primarily, in 1 case osteointegrated implants have been positioned in the graft to be fitted with conventional dentures. Simmetry and contour of the mandible were judged to be good and excellent in all patients as well as mandible range of motion. Fibula free flap has the advantage of bicortical shape, ample lenght, possibility of segmentation and contour, distant location of donor site (to allow a team approach) and low donor site morbidity. For these reasons we consider it the flap of choice in mandible reconstruction expecially when the bony defect is prevalent and soft tissue loss is limited.