Oromandibular Reconstruction with Frozen Mandible and Forearm Flap after Cancer Resection

Fibula, iliac crest, and scapula represent the technique of choice in mandibular reconstruction. The author resented still preliminary results using the mandible itself, sterilized with immersion into liquid nitrogen and covered with a forearm flap. He emphasized the importance of the forearm flap to get a perfect watertight closure of the oral cavity and to minimize the risk of exposure and infection of the graft.

Between January 1996 and January 2003 at the Head and Neck Cancer Department of the National Cancer Institute of Milan, and from September 2003 to January 2005 at the Cervico-Maxillo-Facial Cancer Unit of the Galeazzi Institute of Milan, 35 patients underwent an immediate mandibular reconstruction with an autogenous mandibular graft. The frozen bone was covered with a classical fascio-cutaneous forearm flap in 14 cases; in 18 cases, the radial periostium was included and in 3 cases, the bone. In the postoperative period, 12 of the 35 patients developed a suture dehiscence; this event brought about infection and caused 6 graft removals, while 5 were still in place but in uncertain situation. One dehiscence healed completely with local antibiotic therapy; in one case, the mandible was removed and replanted 3 months later with a successful outcome.

A long-term result of the reconstruction must exclude 9 patients: 6 because of recurrence within 5 months; two have been lost to follow-up soon after the operation; and one had a total flap necrosis. Of 26 patients viable, 6 had the graft removed, 5 still have the graft with a questionable final result, and 14 had complete success. Summarizing, there was a 6/26 failure (23%) and 20/26 good results (77%).

The advantages of the frozen mandible replant technique are reduced donor- site morbidity, the best morphological result, and a low cost. The disadvantages include the high rate of complications, and the doubtful possibility of inserting osseous implants into the graft. These disadvantages are slowly disappearing as experiences proceed.