Pedicle Bone Graft and Free Skin Flap for Reconstruction of Compound Mandibular Defects

Vascularized bone graft is most resistant to oral infection and adjuvant postoperative radiotherapy. The aim of this study was to use a pedicle bone graft and free skin flap for compound mandibular reconstruction following ablation of head and neck tumors.

Ten patients received pedicle bone graft and free skin flap transfer for compound mandibular defects after tumor ablation from January 2003 to March 2005. All were males with an average age of 50 years. The mandibular defect ranged from 3 to 6 cm, averaging 4.6 cm in length. The intraoral defect ranged from 6.4 to 12.8 cm in size. One patient had a through-and-through defect. The cheek defect was 8.7 cm² in size. The mandibular defect was reconstructed with either horizontal or split sliding osteotomies from the remaining mandibular fragments. All the sliding fragments were attached with well-vascularized muscle flaps. The remaining soft tissues defects were reconstructed with 7 anterolateral thigh flaps, 2 radial forearm flaps, and 1 tongue pedicle flap. Postoperative bone scans and x-rays of the mandible were performed for evaluation of bone viability and bone union.

Mandible symmetry and occlusion were preserved in all the patients. Nine received free skin flap reconstructions. One patient had a failure due to artery insufficiency and needed another anterolateral thigh flap reconstruction. Six of nine patients received the bone scan at 1 week postoperative, revealing good vascularization of the transferred bone. All patients had stable union of bone, except for one who developed osteomyelitis of the mandible requiring surgical treatment. Two patients had deep neck infections and were treated successfully with aggressive antibiotics. Eight patients had postoperative radiotherapy. There was no osteoradionecrosis found.

The procedure is quick and secure for reconstruction of small to moderate defects, and can achieve bone union and good contour of the mandible. There is no additional morbidity of donor sites from the leg or ilium.