Vascularized Fibula Flaps for Mandibular Reconstruction: An Institutional Audit

Abstract

Background: Mandibular defects, when left untreated results in mandibular deviation, malocclusion, patient restriction to soft diet and cosmetic anomaly. For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use of the VFF for mandibular reconstruction following ablative tumour surgery in a limited resource environment. Subjects and Method: This study data represents a cohort of subjects from the maxillofacial, head and neck surgical oncology division of the study institution that underwent mandibular reconstruction with VFF. Data collated comprised; demographic, histopathology, types of mandibulectomy, defect classification, types of vascularised fibula flap reconstruction, bone and pedicle length with or without skin paddle dimension, tourniquet and ischaemic time, overall surgery time, flap outcome, clinical outcome and complications following reconstruction. Result: A total of 27 patients had consecutive mandibular resection over the study period. Of these, 8 patients had VFF reconstruction done. Their age range was between 24-62 years with an average age of 39.4 ± 12.87 years. The predominant histopathological diagnoses were solid/multicystic ameloblastoma with 6 (75%) cases. The predominant defect was LC (Jewer’s classification) related with 5 (62.5%) cases. The average donor bone length was 10.52 ± 3.43 cm. The average pedicle length was 7.55 ± 1.33 cm. A total of 4 (50%) flaps were lost while 4 (50%) flaps were viable. Of the 4 reconstructions with viable flaps, 2 (50%) had good clinicoaesthetic outcomes while the other 2 (50%) had acceptable outcomes. Conclusion: This small sampled study tended to suggest a steeper learning curve with a high failure rate and moderate clinical outcome. Emphasis for start-ups in these environments should be towards building a team across surgical training and nursing care.

Keywords: Vascularised Fibula Flap, Mandible, Reconstruction