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Aesthetic and functional outcomes of microvascular reconstruction of large post-excisional defects of the mandible by using the chimeric double-barrel free fibula flap

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Excision for the ameloblastoma of the mandible and secondary cancer infiltration of the mandible are the most common causes of composite/compound lower jaw defects in our institute. The large post-excisional defects of the mandible challenge the prowess of the reconstructive surgeon. This study was conducted to evaluate the aesthetic and functional outcomes of microvascular reconstruction of large post-excisional defects of the mandible by using the chimeric double-barrel free fibula flap.

Methods

From March 2015 to March 2020, twenty-six patients, consisting of sixteen males and ten females, had undergone primary chimeric double-barrel free fibula flap reconstruction of post-excisional compound/composite defects of the mandible. There were sixteen patients with ameloblastoma and ten patients with infiltrating squamous cell carcinoma of the alveolus of the mandible-stage IVA. The average age of patients with ameloblastoma was 36.4 years, and those with squamous cell carcinoma (SCCA) were 51.3 years. All of them had undergone secondary dental rehabilitation at an average post-op period of 6 months. All patients with SCCA had adjuvant radiotherapy. All of them were followed for an average period of 16.5 months.

Results

Two patients (5%) had vascular insufficiency (one arterial and one venous thrombosis) but were successfully salvaged by early exploration and intervention. One patient (3.8%) had an infection of the reconstructed site, which was treated by infected mini plate removal and directive antibiotic therapy. One patient (3.8%) developed late hardware failure and fracture at the reconstructed site, which was treated conservatively and healed well. All of them had good to excellent functional and aesthetic outcome scores in the Institutional Computed Final Functional and Aesthetic Outcome Scoring system.

Conclusions

The chimeric double-barrel free fibula reconstruction not only provides a good contour in line with the lower border of the residuum lower jaw but also provides the well-vascularized bony stock for Osseo-integrated implants facilitating good functional and aesthetic outcomes. This may be added to the armamentarium of the plastic surgeon for large mandibuloplasties.

Level of evidence: Level IV, Therapeutic.

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Authors and Affiliations

  1. Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, 600003, India

    Balakrishnan Thalaivirithan Margabandu, Swetha Vedhanarayanan & Jaganmohan Janardhanam

  2. Department of Oral and Maxillofacial Surgery, Tamil nadu Governmental Dental college and Hospital, Chennai, 600003, India

    Sethurajan Balasubramanian Sethurajan

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  1. Balakrishnan Thalaivirithan Margabandu
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  2. Swetha Vedhanarayanan
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Correspondence to Balakrishnan Thalaivirithan Margabandu.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional ethical committee approval was obtained for this clinical study (PLS 44/2015).

Conflict of interest

Balakrishnan Thalaivirithan Margabandu, Swetha Vedhanarayanan, Sethurajan Balasubramanian Sethurajan, and Jaganmohan Janardhanam declare no conflict of interest.

Patient consent

All patients recruited in this prospective cohort study had given their informed consent for both the surgical procedures and using the clinical data and photographs for research and publication purposes.

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Margabandu, B.T., Vedhanarayanan, S., Sethurajan, S.B. et al. Aesthetic and functional outcomes of microvascular reconstruction of large post-excisional defects of the mandible by using the chimeric double-barrel free fibula flap. Eur J Plast Surg 46, 1027–1038 (2023). https://doi.org/10.1007/s00238-023-02101-0

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