Use of the free fibular flap in the immediate reconstruction of pediatric mandibular tumors: Report of cases

Reconstruction of mandibular defects after surgical ablation remains a challenging problem for the reconstructive surgeon.Over the years, numerous techniques have been developed to help these patients.Early attempts at autogenous mandibular reconstruction focused on the use of nonvascularized corticocancellous grafts from the rib or iliac crest.1,2 The cortical portion of the graft provided structural support; the cancellous portion was required for osteoneogenesis.Revascularization occurred from the surrounding soft-tissue envelope.The results wereinconsistent, especially when Iarge grafts were used or when they were placed in irradiated or poorly vascularized beds.In the 1970s, attempts were made to improve the vascularity ofthese grafts.u Regional muscle flaps were pedicled with underlying bone into mandibular defects to provide both osseous support and soft tissue.These techniques have several disadvantages.The blood supply between the muscle and the periosteal circulation of the bone is often tenuous.Many of the combined bone and soft-tissue transfers are bulky, especially for the repair ofdefects in the anterior floor of the mouth.It is not possible, however, to transfer a bone-only flap with these techniques because the muscle-is needed as a vascular carrier.Moreover, reconstruction with a