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Choice of osseous and osteocutaneous flaps for mandibular reconstruction

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Abstract

Microvascular free flap transfer currently represents one of the most popular methods for mandibularreconstruction. With the various free flap options nowavailable, there is a general consensus that no single kindof osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either “lateral” or “anterior” and the soft-tissue defect is classified as “none,” “skin or mucosal,” or “through-and-through.” For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is “lateral” and the soft tissue is not defective, the ilium is the best choice. When the bony defect is “lateral” and a small “skin or mucosal” soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is “lateral” and an extensive “skin or mucosal” or “through-and-through” soft-tissue defect exists, the scapula should be selected. When the bony defect is “anterior,” the fibula should always be selected. However, when an “anterior” bone defect also displays an “extensive” or “through-and-through” soft-tissue defect, the fibula should be usedwith other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.

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References

  1. PG Cordeiro DA Hidalgo (1995) ArticleTitleConceptual considerations in mandibular reconstruction Clin Plast Surg 22 61–69 Occurrence Handle7743710

    PubMed  Google Scholar 

  2. YB Chen HC Chen LH Hahn (1994) ArticleTitleMajor mandibular reconstruction with vascularized bone grafts: indications and selection of donor tissue Microsurgery 15 227–237 Occurrence Handle8035667

    PubMed  Google Scholar 

  3. T Nakatsuka K Harii A Yamada et al. (1992) ArticleTitleDual free flap transfer using forearm flap for mandibular reconstruction Head Neck 14 452–458 Occurrence Handle1468916

    PubMed  Google Scholar 

  4. ML Urken H Weinberg C Vickery et al. (1992) ArticleTitleThe combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects Laryngoscope 102 543–558 Occurrence Handle1573952

    PubMed  Google Scholar 

  5. FC Wei F Demirkan HC Chen et al. (1999) ArticleTitleDouble free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer Plast Reconstr Surg 103 39–47 Occurrence Handle9915162

    PubMed  Google Scholar 

  6. F McDowell D Ohlwiler (1962) ArticleTitleMandibular resection and replacement. Collective review Int Abstr Surg 115 103–114

    Google Scholar 

  7. VH Kazanjian JM Converse (1959) The surgical treatment of facial injuries Williams & Wilkins Baltimore

    Google Scholar 

  8. H Delageniere (1916) ArticleTitlePeriosteal grafts placed on the tibia Bull Mem Soc Chir Paris 42 1048–1051

    Google Scholar 

  9. TG Blocker RA Stout (1949) ArticleTitleMandibular reconstruction in World War II Plast Reconstr Surg 4 153–156

    Google Scholar 

  10. JB Brown B Cannon (1947) ArticleTitleRepair of major defects of the face Ann Surg 126 624–632

    Google Scholar 

  11. JJ Longacre GA Destefano (1957) ArticleTitleFurther observations of the behavior of autogenous split-rib grafts in reconstruction of extensive defects of the cranium and face Plast Reconstr Surg 20 281–296 Occurrence Handle13494206

    PubMed  Google Scholar 

  12. GB New JB Erich (1944) ArticleTitleBone grafts to the mandible Am J Surg 63 153–167 Occurrence Handle10.1016/S0002-9610(44)90260-6

    Article  Google Scholar 

  13. H Marino NB Turco M Craviotto (1949) ArticleTitleImmediate reconstruction of the lower jaw following surgical excision of large tumors Plast Reconstr Surg 4 36–44

    Google Scholar 

  14. GE Ward JO Robben (1951) ArticleTitleA composite operation for radical neck dissection and removal of cancer of the mouth Cancer 4 98–109 Occurrence Handle14801776

    PubMed  Google Scholar 

  15. JM Converse RM Campbell (1954) ArticleTitleBone grafts in surgery of the face Surg Clin North Am 34 375–401

    Google Scholar 

  16. DR Millard V Dembrow E Shocket et al. (1967) ArticleTitleImmediate reconstruction of the resected mandibular arch Am J Surg 114 605–613 Occurrence Handle10.1016/0002-9610(67)90026-8 Occurrence Handle5341546

    Article  PubMed  Google Scholar 

  17. BE Bromberg RH Walden LR Rubin (1963) ArticleTitleMandibular bone grafts. A technique in fixation Plast Reconstr Surg 32 589–599 Occurrence Handle14103013

    PubMed  Google Scholar 

  18. AK Adamo RL Szal (1979) ArticleTitleTiming, results, and complications of mandibular reconstructive surgery: report of 32 cases J Oral Surg 37 755–763 Occurrence Handle383922

    PubMed  Google Scholar 

  19. RC Hamaker (1981) ArticleTitleIrradiation of autogenous mandibular grafts in primary reconstructions Laryngoscope 91 1031–1051 Occurrence Handle7017313

    PubMed  Google Scholar 

  20. VP Blair (1918) Surgery and diseases of the mouth and jaw CV Mosby St. Louis

    Google Scholar 

  21. CC Snyder JM Bateman CW Davis et al. (1970) ArticleTitleMandibulo-facial restoration with live osteocutaneous flaps Plast Reconstr Surg 45 14–19 Occurrence Handle4902837

    PubMed  Google Scholar 

  22. J Conley (1972) ArticleTitleUse of composite flaps containing bone for major repairs in the head and neck Plast Reconstr Surg 49 522–526 Occurrence Handle4554701

    PubMed  Google Scholar 

  23. S Ariyan (1980) ArticleTitlePectoralis major, sternomastoid, and other musculocutaneous flaps for head and neck reconstruction Clin Plast Surg 7 89–109 Occurrence Handle6988149

    PubMed  Google Scholar 

  24. W Panje C Cutting (1980) ArticleTitleTrapezius osteomyocutaneous island flap for reconstruction of the anterior floor of the mouth and the mandible Head Neck Surg 3 66–71 Occurrence Handle6997238

    PubMed  Google Scholar 

  25. FV Mignogna R Rankow KF Garay (1993) ArticleTitleA–O reconstruction plate and sternal osteomyocutaneous flap in primary mandibular reconstruction Am J Surg 166 416–420 Occurrence Handle8214305

    PubMed  Google Scholar 

  26. RK Daniel (1977) ArticleTitleFree rib transfer by microvascular anastomoses Plast Reconstr Surg 59 737–738 Occurrence Handle850710

    PubMed  Google Scholar 

  27. D Serafin A Villarreal-Rios NG Georgiade (1977) ArticleTitleA rib-containing free flap to reconstruct mandibular defects Br J Plast Surg 30 263–266 Occurrence Handle10.1016/0007-1226(77)90113-8 Occurrence Handle588790

    Article  PubMed  Google Scholar 

  28. T Harashina H Nakajima T Imai (1978) ArticleTitleReconstruction of mandibular defects with revascularized free rib grafts Plast Reconstr Surg 62 514–522 Occurrence Handle358231

    PubMed  Google Scholar 

  29. BM O’Brien WA Morrison AM MacLeod et al. (1979) ArticleTitleMicrovascular osteocutaneous transfer using the groin flap and iliac crest and the dorsalis pedis flap and second metatarsal Br J Plast Surg 32 188–206 Occurrence Handle10.1016/0007-1226(79)90032-8 Occurrence Handle380703

    Article  PubMed  Google Scholar 

  30. MS Bell PT Barron (1980) ArticleTitleA new method of oral reconstruction using a free composite foot flap Ann Plast Surg 5 281–287 Occurrence Handle6985506

    PubMed  Google Scholar 

  31. AM MacLeod DW Robinson (1982) ArticleTitleReconstruction of defects involving the mandible and floor of mouth by free osteo-cutaneous flaps derived from the foot Br J Plast Surg 35 239–246 Occurrence Handle10.1016/0007-1226(82)90108-4 Occurrence Handle6758897

    Article  PubMed  Google Scholar 

  32. RK Daniel (1978) ArticleTitleMandibular reconstruction with free tissue transfers Ann Plast Surg 1 346–371 Occurrence Handle365058

    PubMed  Google Scholar 

  33. GI Taylor P Townsend R Corlett (1979) ArticleTitleSuperiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work Plast Reconstr Surg 64 745–759 Occurrence Handle390575

    PubMed  Google Scholar 

  34. AH Salibian I Rappaport G Allison (1985) ArticleTitleFunctional oromandibular reconstruction with the microvascular composite groin flap Plast Reconstr Surg 76 819–828 Occurrence Handle3906715

    PubMed  Google Scholar 

  35. L Teot JP Bosse R Mourfarrege (1981) ArticleTitleThe scapular crest pedicled bone graft Int J Microsurg 3 257–262

    Google Scholar 

  36. WM Swartz JC Banis ED Newton et al. (1986) ArticleTitleThe osteocutaneous scapular flap for mandibular and maxillary reconstruction Plast Reconstr Surg 77 530–545 Occurrence Handle3952209

    PubMed  Google Scholar 

  37. SR Baker MJ Sullivan (1988) ArticleTitleOsteocutaneous free scapular flap for one-stage mandibular reconstruction Arch Otolaryngol Head Neck Surg 114 267–277 Occurrence Handle3342119

    PubMed  Google Scholar 

  38. DA Hidalgo (1989) ArticleTitleFibula free flap: a new method of mandible reconstruction Plast Reconstr Surg 84 71–79 Occurrence Handle2734406

    PubMed  Google Scholar 

  39. AF Flemming MD Brough ND Evans et al. (1990) ArticleTitleMandibular reconstruction using vascularised fibula Br J Plast Surg 43 403–409 Occurrence Handle10.1016/0007-1226(90)90003-I Occurrence Handle2393766

    Article  PubMed  Google Scholar 

  40. FC Wei CS Seah YC Tsai et al. (1994) ArticleTitleFibula osteoseptocutaneous flap for reconstruction of composite mandibular defects Plast Reconstr Surg 93 294–304 Occurrence Handle8310021

    PubMed  Google Scholar 

  41. DS Soutar IA McGregor (1986) ArticleTitleThe radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases Plast Reconstr Surg 78 1–8 Occurrence Handle3725941

    PubMed  Google Scholar 

  42. DS Soutar WP Widdowson (1986) ArticleTitleImmediate reconstruction of the mandible using a vascularized segment of radius Head Neck Surg 8 232–246 Occurrence Handle3744854

    PubMed  Google Scholar 

  43. A Thoma M Allen BH Tadeson et al. (1995) ArticleTitleThe fate of the osteotomized free radial forearm osteocutaneous flap in mandible reconstruction J Reconstr Microsurg 11 215–219 Occurrence Handle7650648

    PubMed  Google Scholar 

  44. LT Byars (1946) ArticleTitleSubperiosteal mandibular resection with internal bar fixation Plast Reconstr Surg 1 236–239

    Google Scholar 

  45. BS Freeman (1948) ArticleTitleThe use of vitallium plates to maintain function following resection of the mandible Plast Reconstr Surg 3 73–78

    Google Scholar 

  46. JJ Conley (1951) ArticleTitleThe use of vitallium prostheses and implants in the reconstruction of the mandibular arch Plast Reconstr Surg 8 150–162 Occurrence Handle14875517

    PubMed  Google Scholar 

  47. MT Edgerton G Ward TE Sikes (1950) ArticleTitleFixation and plastic repair after partial mandibular resection Plast Reconstr Surg 5 231

    Google Scholar 

  48. MJ Healy SuffixJr JL Sudbay HH Niebel et al. (1954) ArticleTitleThe use of acrylic implants in one-stage reconstruction of the mandible Surg Gynecol Obstet 98 395–406 Occurrence Handle13146492

    PubMed  Google Scholar 

  49. CM Phillips (1967) ArticleTitlePrimary and secondary reconstruction of the mandible after ablative surgery. Report of 24 cases using stainless steel prostheses Am J Surg 114 601–604 Occurrence Handle10.1016/0002-9610(67)90025-6 Occurrence Handle6038744

    Article  PubMed  Google Scholar 

  50. PG Cordeiro DA Hidalgo (1994) ArticleTitleSoft-tissue coverage of mandibular reconstruction plates Head Neck 16 112–115 Occurrence Handle8021129

    PubMed  Google Scholar 

  51. JB Boyd RS Mulholland J Davidson et al. (1995) ArticleTitleThe free flap and plate in oromandibular reconstruction: long-term review and indications Plast Reconstr Surg 95 1018–1028 Occurrence Handle7732110

    PubMed  Google Scholar 

  52. T Vuillemin J Raveh F Sutter (1988) ArticleTitleMandibular reconstruction with the titanium hollow screw reconstruction plate (THORP) system: evaluation of 62 cases Plast Reconstr Surg 82 804–814 Occurrence Handle3174870

    PubMed  Google Scholar 

  53. JC Irish PJ Gullane RW Gilbert et al. (1995) ArticleTitlePrimary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases Plast Reconstr Surg 96 93–99 Occurrence Handle7604137

    PubMed  Google Scholar 

  54. LT Ostrup JM Fredrickson (1974) ArticleTitleDistant transfer of a free, living bone graft by microvascular anastomoses. An experimental study Plast Reconstr Surg 54 274–285 Occurrence Handle4604335

    PubMed  Google Scholar 

  55. DW McCullough JM Fredrickson (1973) ArticleTitleNeovascularized rib grafts to reconstruct mandibular defects Can J Otolaryngol 2 96–100

    Google Scholar 

  56. JD Schlenker AT Indresano T Raine et al. (1980) ArticleTitleA new flap in the dog containing a vascularized rib graft – the latissimus dorsi myoosteocutaneous flap J Surg Res 29 172–183 Occurrence Handle10.1016/0022-4804(80)90035-9 Occurrence Handle7412260

    Article  PubMed  Google Scholar 

  57. K Ohmori K Harii (1976) ArticleTitleFree dorsalis pedis sensory flap to the hand, with microneurovascular anastomoses Plast Reconstr Surg 58 546–554 Occurrence Handle790428

    PubMed  Google Scholar 

  58. AH Salibian I Rappaport DW Furnas et al. (1980) ArticleTitleMicrovascular reconstruction of the mandible Am J Surg 140 499–502 Occurrence Handle10.1016/0002-9610(80)90199-3 Occurrence Handle6999926

    Article  PubMed  Google Scholar 

  59. IB Rosen RT Manktelow RM Zuker et al. (1985) ArticleTitleApplication of microvascular free osteocutaneous flaps in the management of post-radiation recurrent oral cancer Am J Surg 150 474–479 Occurrence Handle10.1016/0002-9610(85)90157-6 Occurrence Handle3901789

    Article  PubMed  Google Scholar 

  60. RM Zuker RT Manktelow (1986) ArticleTitleThe dorsalis pedis free flap: technique of elevation, foot closure, and flap application Plast Reconstr Surg 77 93–104 Occurrence Handle3941854

    PubMed  Google Scholar 

  61. GI Taylor N Watson (1978) ArticleTitleOne-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone Plast Reconstr Surg 61 494–506 Occurrence Handle345302

    PubMed  Google Scholar 

  62. GI Taylor (1982) ArticleTitleReconstruction of the mandible with free composite iliac bone grafts Ann Plast Surg 9 361–376 Occurrence Handle6758673

    PubMed  Google Scholar 

  63. DD Jewer JB Boyd RT Manktelow et al. (1989) ArticleTitleOrofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification Plast Reconstr Surg 84 391–403 Occurrence Handle2762397

    PubMed  Google Scholar 

  64. ML Urken C Vickery H Weinberg et al. (1989) ArticleTitleThe internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction J Reconstr Microsurg 5 203–214 Occurrence Handle2769625

    PubMed  Google Scholar 

  65. K Harii A Yamada T Nakatsuka et al. (1991) ArticleTitleReconstruction of the mandible with a vascularized iliac bone or osteocutaneous flap Jpn J Plast Reconstr Surg 34 47–58

    Google Scholar 

  66. JL Frodel SuffixJr GF Funk DT Capper et al. (1993) ArticleTitleOsseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps Plast Reconstr Surg 92 449–455 Occurrence Handle8341743

    PubMed  Google Scholar 

  67. A Gilbert L Teot (1982) ArticleTitleThe free scapular flap Plast Reconstr Surg 69 601–604 Occurrence Handle7071198

    PubMed  Google Scholar 

  68. LF dos Santos (1984) ArticleTitleThe vascular anatomy and dissection of the free scapular flap Plast Reconstr Surg 73 599–604 Occurrence Handle6709742

    PubMed  Google Scholar 

  69. MS Granick ED Newton DC Hanna (1986) ArticleTitleScapular free flap for repair of massive lower facial composite defects Head Neck Surg 8 436–441 Occurrence Handle3721886

    PubMed  Google Scholar 

  70. T Nakatsuka K Harii A Yamada et al. (1996) ArticleTitleSurgical treatment of mandibular osteoradionecrosis: versatility of the scapular osteocutaneous flap Scand J Plast Reconstr Surg Hand Surg 30 291–298 Occurrence Handle8976024

    PubMed  Google Scholar 

  71. JJ Coleman Suffix3rd MR Sultan (1991) ArticleTitleThe bipedicled osteocutaneous scapula flap: a new subscapular system free flap Plast Reconstr Surg 87 682–692 Occurrence Handle2008466

    PubMed  Google Scholar 

  72. OK Coskunfirat (1999) ArticleTitleFree vascularized fibula transfer: who was first? Plast Reconstr Surg 104 1202–1203

    Google Scholar 

  73. GI Taylor GD Miller FJ Ham (1975) ArticleTitleThe free vascularized bone graft. A clinical extension of microvascular techniques Plast Reconstr Surg 55 533–544 Occurrence Handle1096183

    PubMed  Google Scholar 

  74. Y Ueba S Fujikawa (1983) ArticleTitleNine years’ follow-up of a free vascularized fibular graft in neurofibromatosis: a case report and literature review Jpn J Orthop Trauma Surg 26 595–600

    Google Scholar 

  75. BM O’Brien GJ Gumley BJ Dooley et al. (1988) ArticleTitleFolded free vascularized fibula transfer Plast Reconstr Surg 82 311–318 Occurrence Handle3399561

    PubMed  Google Scholar 

  76. DA Hidalgo A Rekow (1995) ArticleTitleA review of 60 consecutive fibula free flap mandible reconstructions Plast Reconstr Surg 96 585–596 Occurrence Handle7638283

    PubMed  Google Scholar 

  77. DS Soutar LR Scheker NS Tanner et al. (1983) ArticleTitleThe radial forearm flap: a versatile method for intra-oral reconstruction Br J Plast Surg 36 1–8 Occurrence Handle10.1016/0007-1226(83)90002-4 Occurrence Handle6821714

    Article  PubMed  Google Scholar 

  78. A Thoma R Khadaroo O Grigenas et al. (1999) ArticleTitleOromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases Plast Reconstr Surg 104 368–378 Occurrence Handle10654679

    PubMed  Google Scholar 

  79. N Weinzweig NF Jones KC Shestak et al. (1994) ArticleTitleOromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap Ann Plast Surg 33 359–369 Occurrence Handle7810951

    PubMed  Google Scholar 

  80. M Butterworth PE Butler (2000) ArticleTitleRadial forearm osteocutaneous flap for head and neck reconstruction Plast Reconstr Surg 106 1425–1426 Occurrence Handle10.1097/00006534-200011000-00039 Occurrence Handle11083579

    Article  PubMed  Google Scholar 

  81. A Takushima (2002) ArticleTitleAuthor reply to Harris PA and Butler PE. Radial forearm osteocutaneous flap for mandibular reconstruction Plast Reconstr Surg 110 1196 Occurrence Handle10.1097/00006534-200209150-00046

    Article  Google Scholar 

  82. A Takushima K Harii H Asato et al. (2001) ArticleTitleMandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases Plast Reconstr Surg 108 1555–1563 Occurrence Handle10.1097/00006534-200111000-00018 Occurrence Handle11711927

    Article  PubMed  Google Scholar 

  83. JF Moscoso J Keller E Genden et al. (1994) ArticleTitleVascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants Arch Otolaryngol Head Neck Surg 120 36–43 Occurrence Handle8274254

    PubMed  Google Scholar 

  84. DJ David E Tan J Katsaros et al. (1988) ArticleTitleMandibular reconstruction with vascularized iliac crest: a 10-year experience Plast Reconstr Surg 82 792–803 Occurrence Handle3174869

    PubMed  Google Scholar 

  85. PG Cordeiro JJ Disa DA Hidalgo et al. (1999) ArticleTitleReconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients Plast Reconstr Surg 104 1314–1320 Occurrence Handle10513911

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Akihiko Takushima, Kiyonori Harii & Akira Momosawa

  2. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Hirotaka Asato & Mutsumi Okazaki

  3. Department of Plastic and Reconstructive Surgery, Saitama Medical School, Saitama, Japan

    Takashi Nakatsuka

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  1. Akihiko Takushima
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  2. Kiyonori Harii
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  3. Hirotaka Asato
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  4. Akira Momosawa
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  5. Mutsumi Okazaki
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  6. Takashi Nakatsuka
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Correspondence to Akihiko Takushima.

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Takushima, A., Harii, K., Asato, H. et al. Choice of osseous and osteocutaneous flaps for mandibular reconstruction. Int J Clin Oncol 10, 234–242 (2005). https://doi.org/10.1007/s10147-005-0504-y

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