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Reconstruction of the Through‐and‐Through Anterior Mandibulectomy Defect: Indications and Limitations of the Double‐Skin Paddle Fibular Free Flap
Author(s) -
Deleyiannis Frederic W.B.,
Rogers Carolyn,
Ferris Robert L.,
Lai Stephen Y.,
Kim Seungwon,
Johnson Jonas
Publication year - 2008
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/mlg.0b013e3181734f60
Subject(s) - medicine , free flap , surgery , fibula , fistula , thigh , anatomy , tibia
Objectives/Hypothesis: The purpose of this report is to describe our recent experience using a double‐skin paddle fibular free flap (DSPFFF) for reconstruction of the through‐and‐through anterior mandibulectomy defect and to present a reconstructive algorithm based on the extent of lip and mental skin resection. Study Design: Retrospective review of 10 consecutive patients with through‐and‐through anterior mandibulectomy defects. Methods: Outcomes that were examined included methods of reconstruction based on the cutaneous defect, flap complications, fistula rate, and donor site complications. Results: Seven patients were reconstructed with a DSPFFF. For lip reconstruction, two patients were also concomitantly reconstructed with Karapandzic or lip advancement flaps. Three patients were reconstructed with both a fibular free flap and a second free flap (1 radial forearm fasciocutaneous flap and 2 anterolateral thigh flaps). The transverse dimensions of the DSPFFFs were as great as 15 cm. None of the patients developed a fistula. All free tissue transfers were successful. One patient developed partial loss of the fibular skin paddle used for submental skin replacement. Conclusions: DSPFFF is a safe and reliable way to reconstruct an anterior through‐and‐through mandibular defect. Indications for using a DSPFFF are 1) a cutaneous defect that lies at or below the plane of the reconstructed mandible, 2) a transverse width of the oral mucosa and cutaneous defect that does not exceed 15 cm (the approximate distance from the mid‐calf to the anterior midline), and 3) a lip defect that, if present, can be reconstructed with local flaps.