부산대학교 도서관

Mandibular defects result from resection of tumors, osteomyelitic or osteoradionecrotic lesions, or trauma. Soft tissue involvement surrounding the mandible results in even larger and more complicated defects that require delicate shaping of the hard and soft tissue components of the flaps used for reconstruction. Although the iliac crest free flap and the scapula free flap can be used for reconstructing these defects, the authors favor the fibula osteoseptocutaneous flap as it provides a large bony segment that can be safely osteotomized and can be transferred with a reliable skin paddle. For large defects missing multiple tissue components, more than one flap may be required for an optimal reconstruction. The favored combination at this institution is the fibula osteoseptocutaneous free flap along with the anterolateral thigh free flap. In a selected group of patients osteointegrated implants are offered for eventual dental implant placement. This can be performed during the primary operation in patients with mandibular defects resulting from the excision of benign lesions and in some nonbenign lesions with excellent prognoses; otherwise they are performed secondarily. The harvest, contouring, and inset of the flap as well as accurate placement of osteointegration implants are important for achieving a result that allows long-term functional results and aesthetic success for the patient.