Introduction: Reconstruction of the oromandibular region defects is complex and challenging with
regard to both functional and aesthetic outcomes. The ideal reconstruction should
mimic the missing tissue with regard to geometry and tissue character, enabling a
fast rehabilitation of mastication, phonation and deglutition. We intend to show our
therapeutic approach to this type of defects, our preference being the use of free
flaps, namely osteoseptocutaneous fibula flap and fasciocutaneous radial forearm flap,
depending on bone involvement.
Methodology and Material: From May 2012 to January 2014, 11 reconstructions of complex oromandibular defects
using free flaps were performed at Hospital de Santa Maria. The etiology was tumoral
in 9 cases (82%) and traumatic in the remaining 2 cases (18%). The defects were of
two types: soft tissue defects with or without bone involvement.
Results: During this period 11 free flaps were performed to reconstruct defects of the oromandibular
region in 11 patients (8 males and 3 females): 4 osteoseptocutaneous fibula flaps,
6 radial forearm flaps and 1 anterolateral thigh flap. The mean age of patients was
46 years (20-62 years). Neck dissection and adjuvant radiotherapy was performed in
73% of patients (89% of patients with tumor etiology). The survival rate of the flaps
was 100%. There were no major postoperative complications, most notably only 3 cases
of minor wound dehiscence, 4 cases of difficult healing of the donor area and 1 case
of soft tissue infection. There was need for re-intervention in 4 cases (closure of
dehiscence, graft donor area, debridement of abscess and scar correction). Overall,
functional (mastication, phonation and deglutition) and aesthetic results were good.
Conclusions: The reconstruction of complex oromandibular defects with the use of free flaps, namely
radial forearm flap or fibula flap, is a safe and reliable reconstructive option,
which allows good aesthetic results and a rapid functional rehabilitation.
