Purpose: The vascularized free fibula flap (VFFF) has become the popular reconstruction method after mandibular resection due to advantages of enough bone graft length and accepting dental implants. However, using a single fibula bone may have height discrepancy between the native mandible and grafted fibula which results in subsequent difficulty in wearing conventional dentures or osseintegrated implants. Several options could be used to resolve this problem such as delayed onlay bone graft, iliac bone reconstruction, fibula distraction and double barrel fibula flap graft. This article describes our experience in reconstruction of segmental mandible defect with double barrel fibula flap and denture rehabilitation.
Materials and methods : This procedure was used in 7 patients. A donor site fibula corresponding to at least twice the length of the mandibular defect was harvested. Double barrel free fibula graft was performed in 6 primary reconstructive patients and 1 secondary patient, including 3 osteocutaneous flap with skin islands in reconstruction of composite defect of malignant tumor. The prosthodontic treatment was completed in all 7 patients. 4 patients received secondary stage implant supported dental reconstruction and 3 patients who received radiation of 6000 cGy after graft surgery had conventional removable partial denture prosthesis.
Results: Microvascular fibula transfers are completely successful and all skin paddles have survived without necrosis. Original mandibular contour was maintained by a reconstruction plate, the reconstruction mandibular length is from 6.5 to 10 cm, the reconstruction height of the double barrel fibula is from 3.0-3.8 cm and all the patients were satisfied with postoperative faces and chewing function from the implant supported denture and removable partial prosthesis.
Conclusions: Mandibular segmental defects could be aesthetically and functionally reconstructed by double barrel vascularized fibula flap which not only matched the height of the native mandible but also allowed osteointeragrated dental implantation for dental rehabilitation.