Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer Journal Article

Authors: Mosahebi, A.; Chaudhry, A.; McCarthy, C. M.; Disa, J. J.; Mehrara, B. J.; Pusic, A. L.; Hu, Q.; Cordeiro, P. G.
Article Title: Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer
Abstract: Background: The management of composite oromandibular defects involving the posterolateral mandible and surrounding soft tissue remains a reconstructive challenge. Although bony reconstitution restores continuity of the mandible, osteocutaneous flaps sometimes do not provide adequate soft-tissue coverage of these postablative defects. The purpose of this study was to evaluate the use of soft-tissue flaps for extensive posterolateral oromandibular defects. Methods: Consecutive patients who underwent reconstruction of composite oromandibular defects following posterolateral mandibulectomy between 1992 and 2006 were identified. Patient data were obtained from a prospectively maintained clinical database. Medical records were reviewed to characterize the extent of all postablative soft-tissue defects. Soft-tissue resection zones were defined as those involving the external cheek skin and/or lips, intraoral lining, tongue, retromolar trigone, palate, pharynx, and/or esophagus. Results: In total, 76 patients were identified as having extensive posterolateral oromandibular defects reconstructed with soft-tissue flaps alone. In 62 percent of patients who underwent nonosseous free-tissue transfer, the oromandibular defect involved two or more soft-tissue zones. The most common flap used was the vertical rectus myocutaneous flap (n = 68). At the time of discharge, 54 percent of patients were on an oral diet. Sixty percent of patients had intelligible speech. Overall aesthetic outcome was good in 49 percent, fair in 21 percent, and poor in 30 percent of patients. Conclusions: Extensive composite defects of the posterolateral mandibular can be repaired effectively using soft-tissue flaps alone. When reconstructing a defect involving (1) the posterolateral mandible, overlying soft-tissues, and external skin and/or (2) the posterolateral mandible and two or more adjacent soft-tissue zones, the use of a soft-tissue flap alone can maximize success. © 2009 by the American Society of Plastic Surgeons.
Keywords: adolescent; adult; child; treatment outcome; aged; aged, 80 and over; child, preschool; middle aged; reconstructive surgical procedures; retrospective studies; young adult; carcinoma, squamous cell; surgical flaps; mouth neoplasms; mouth; speech; mandible; deglutition; fibula; mandibular neoplasms; rectus abdominis
Journal Title: Plastic and Reconstructive Surgery
Volume: 124
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2009-11-01
Start Page: 1571
End Page: 1577
Language: English
DOI: 10.1097/PRS.0b013e3181b98b78
PUBMED: 20009843
PROVIDER: scopus
Notes: --- - "Export Date: 30 November 2010" - "CODEN: PRSUA" - "Source: Scopus"
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MSK Authors
  1. Joseph Disa
    198 Disa
  2. Andrea Pusic
    280 Pusic
  3. Babak Mehrara
    256 Mehrara
  4. Peter G Cordeiro
    239 Cordeiro
  5. Qun Ying Hu
    22 Hu