J Reconstr Microsurg 2014; 30 - A117
DOI: 10.1055/s-0034-1374019

Free Flap Reconstruction of Complex Oromandibular Defects

Liliana Reis Silva 1, Sara Cunha 1, Eduardo Matos 1, Margarida Henriques 1, Manuel Caneira 1
  • 1Hospital de Santa Maria, Centro Hospitalar Lisboa Norte Avenida Professor Egas Moniz, Lisboa, Portugal

Introduction: Reconstruction of the oromandibular region defects is complex and challenging with regard to both functional and aesthetic outcomes. The ideal reconstruction should mimic the missing tissue with regard to geometry and tissue character, enabling a fast rehabilitation of mastication, phonation and deglutition. We intend to show our therapeutic approach to this type of defects, our preference being the use of free flaps, namely osteoseptocutaneous fibula flap and fasciocutaneous radial forearm flap, depending on bone involvement.

Methodology and Material: From May 2012 to January 2014, 11 reconstructions of complex oromandibular defects using free flaps were performed at Hospital de Santa Maria. The etiology was tumoral in 9 cases (82%) and traumatic in the remaining 2 cases (18%). The defects were of two types: soft tissue defects with or without bone involvement.

Results: During this period 11 free flaps were performed to reconstruct defects of the oromandibular region in 11 patients (8 males and 3 females): 4 osteoseptocutaneous fibula flaps, 6 radial forearm flaps and 1 anterolateral thigh flap. The mean age of patients was 46 years (20-62 years). Neck dissection and adjuvant radiotherapy was performed in 73% of patients (89% of patients with tumor etiology). The survival rate of the flaps was 100%. There were no major postoperative complications, most notably only 3 cases of minor wound dehiscence, 4 cases of difficult healing of the donor area and 1 case of soft tissue infection. There was need for re-intervention in 4 cases (closure of dehiscence, graft donor area, debridement of abscess and scar correction). Overall, functional (mastication, phonation and deglutition) and aesthetic results were good.

Conclusions: The reconstruction of complex oromandibular defects with the use of free flaps, namely radial forearm flap or fibula flap, is a safe and reliable reconstructive option, which allows good aesthetic results and a rapid functional rehabilitation.