Double-barrel fibula vascularized free flap with dental rehabilitation for mandibular reconstruction

Purpose: The vascularized free fibula flap has become the most popular reconstruction method after mandibular resection because of adequate bone graft length and acceptance of dental implants. However, using 1 fibula bone may produce a height discrepancy between the native mandible and the grafted fibula that results in subsequent difficulty in wearing conventional dentures or osteointegrated implants. Several options can 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 the reconstruction of segmental mandible defects with the 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 grafting was performed in 6 patients for primary reconstruction and 1 patient for secondary reconstruction, including 3 cases of osteocutaneous flap with skin islands in the reconstruction of a composite defect from a malignant tumor. Prosthodontic treatment was completed in all 7 patients. Four patients received secondary implant-supported dental reconstruction, and 3 patients who received radiation (6,000 cGy) after graft surgery had conventional removable partial dentures.

Results: Microvascular fibula transfers were completely successful, and all skin paddles survived without necrosis. The original mandibular contour was maintained by a reconstruction plate; the reconstruction mandibular length was 6.5 to 10 cm, the reconstruction height of the double-barrel fibula was 3.0 to 3.8 cm, and all patients were satisfied with the postoperative facial esthetics and chewing function from the implant-supported denture and removable partial prostheses.

Conclusions: Mandibular segmental defects can be esthetically and functionally reconstructed by a double-barrel vascularized fibula flap that not only matches the height of the native mandible but also allows osteointegrated dental implantation for dental rehabilitation.