A Comparison of Vascularized Fibular Flap and Iliac Crest Flap for Mandibular Reconstruction

Abstract

Segmental mandibular defects, which are caused either by ablative surgery or trauma, are usually accompanied by different degrees of skin, soft tissue or mucosa losses. The reconstruction of such defects requires complicated surgical procedures. An ideal mandibular reconstruction method must support the insertion osseointegrated dental implants which is necessary for total oral rehabilitation. The soft tissue defect should also be reconstructed if it accompanies the bony defect. We performed 37 mandibular reconstructions using either vascularized iliac crest flap or fibula flap. Sixteen of 24 patients who underwent mandibular reconstruction using iliac crest flap, and 3 of 13 patients who has been reconstructed with fibula flaps, had mandibular defects involving skin and/or mucosa. Both techniques were compared regarding patients records such as hospital stay, operation time, defect size, etiopathogenesis, skin paddle, blood transfusion, and complication rates. Self-assessment questionnaires were also used to evaluate aesthetic and functional results. When 2 different mandibular reconstruction techniques are compared regarding patient records, the complication rate of fibula flap was less than the iliac crest flap. Functional and aesthetic results also showed that oral continence, social activities, and facial appearance rates of fibula flap were superior to iliac crest flap. Lower complication rates of fibula flap group may be associated with patients' higher satisfaction rate. Both flaps are commonly used in mandibular reconstruction, however, many parameters including defect localization, defect size, presence of soft tissue defect should be considered.