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November 1991

Free Flap Reconstruction of Mandibular Defects

Author Affiliations

San Diego, Calif

Arch Otolaryngol Head Neck Surg. 1991;117(11):1215. doi:10.1001/archotol.1991.01870230019002

The role of microvascular free flap reconstruction of the mandible was discussed by Richard E. Hayden, MD, at the spring meeting of the American Academy of Facial Plastic and Reconstructive Surgery at the Hyatt Regency Waikaloa Resort on the Big Island of Hawaii.

Free flaps provide superior reconstruction of composite mandible resection defects, according to Dr Hayden. Five options for free flap reconstruction were reviewed: radial forearm, iliac crest, metatarsal, scapula, and fibula. The fibula flap is the only free flap that has both of the following: (1) bone long enough to match the largest defects and wide enough to accept osseointegrated implants and (2) neurosensory innervation of the intraoral skin paddle. Preserving the lateral sural cutaneous nerve to the skin paddle at the time of harvest allows anastomosis to the lingual nerve. Healing brings sensory innervation to the skin paddle. A cable nerve graft from the sural nerve can

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