Introduction: The main objectives in mandibular reconstruction search to recover shape, function and aesthetics. To achieve these objectives free flaps are performed. Currently fibula and iliac crest free flap are the main options for mandibular reconstruction. Preoperative planning and rapid prototyping, let us achieve better results, obtaining a better tridimensional reconstruction. Nevertheless it does not exist a treatment protocol to use the best flap for mandibular reconstruction, depending on the type of mandibular defect, initial diagnosis, bone free flap qualities, need for further dental rehabilitation or the association of an intraoral or extraoral soft tissue defect. Many factors should be considered, including the preference of the surgical team, to choose the ideal reconstruction flap. We review our experience, surgical technique and indications for free fibula and iliac crest, to establish our surgical protocol for mandibular reconstruction.

Patients and methods: A retrospective study of the cases treated in our department from 2010 to 2013 for mandibular reconstruction using fibula or iliac crest is done.

Results: A total of 25 cases were treated for mandibular reconstruction with fibula flap or iliac crest. Diagnosis includes primary and secondary reconstruction for oscc, osteoradionecrosis, ossifiying fibroma, ameloblastoma, and central mucoepidermoid carcinoma. Thirteen fibula flaps and twelve iliac crest flap where harvested. Main indications for fibula flap were extense defects of more than 10 cm and the need for extraoral soft tissue cover. Inner table iliac free flap was indicated when the defect was less than 10 cm, no extraoral cover was needed, and when dental implants were planned.

Conclusions: Inner table iliac free flap and fibula free flap cover the best options for mandibular reconstruction. Flap election will be influenced mainly by the defect size, association of soft tissue defects, future dental rehabilitation and surgical experience. Refinements in flap harvesting are essential to reduce donor site morbidity.