Microvascular Free Bone Flaps

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Basic principles

Reconstructive surgeons must understand fully the anticipated defect before preoperative planning can begin. It is important that surgeons carefully evaluate the operative site, review appropriate imaging, and discuss the planned operation with other surgeons involved in the case to comprehend the anticipated defect in three dimensions. Microvascular surgeons must select the most appropriate donor site, consider the vessel geometry, and devise a plan for shaping, contouring, and insetting the

Background

The fibula flap has gained a well-deserved reputation for reliability, ease of harvest, and suitability for definitive implant-supported dental rehabilitation. A few oral and maxillofacial surgeons proclaim this flap unsuitable for mandibular reconstruction. The fibula mandibular reconstruction is different in appearance and height in comparison to the native mandible in some cases. The literature that describes success with the flap for this purpose and the senior author's extensive experience

Background

The DCIA flap was developed from early experience with the groin flap. The proper vascular pedicle for the osteomusculocutaneous flap was determined to be the DCIA and vein. These vessels arise from the external iliac artery and vein just above the inguinal ligament. They have average diameters of 2 to 3 mm. The ascending branch of the DCIA provides the blood supply to the internal oblique muscle, which has become the favored soft tissue for harvest with the flap. Harvesting a well-vascularized

Background

The free radial forearm fasciocutaneous flap has excellent use in head and neck surgery primarily because of the thin, pliable character of the tissue and the reliability of its vasculature. A major advantage of the flap is that the distant location of the flap donor site allows simultaneous flap harvest and cancer resection or recipient site preparation. The use of this flap as a bone-containing flap is, however, somewhat limited because of the minimal volume of bone that can be harvested. The

Background

The scapula free flap is based on the circumflex scapular artery and vein. These vessels are of large caliber, with common diameters of 4 mm (range 2–6 mm). This flap has perhaps the most versatility and adaptability of any of the bone-containing microvascular free flaps in common usage. The flap is generally reserved for specific indications in head and neck reconstruction because of the challenges imposed by the need to reposition the patient to allow flap harvest and the donor site morbidity

Case #1: Lateral mandibular resection for osteoradionecrosis

The patient is a 45-year-old white man who 4 years ago underwent right radical neck dissection and combined modality chemotherapy-radiation therapy for tongue base squamous cell carcinoma. He had undergone extraction of partially impacted third molars 3 weeks before initiation of radiation therapy. The left third molar site never healed, and osteoradionecrosis developed. He received approximately 45 hyperbaric oxygen therapy treatments and numerous courses of antibiotic therapy without

Summary

Microvascular free bone flaps are a modern means of restoring bone-containing composite defects of the maxillofacial region. The techniques are simple and reliable. The results are reproducible and offer significant advantages over staged mandibular reconstruction. In particular, these techniques decrease costs and provide a means of rapid definitive reconstruction. Patients avoid multiple surgical procedures with immediate reconstruction that allows them to return to productive lives in

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