MANDIBULAR RECONSTRUCTION WITH VASCULARISED FREE FIBULA FLAP.

Objective: To study etiology of mandibular defects, the versatility of vascularised free fibula flap, the functional and cosmetic outcome in patients undergoing mandibular reconstruction and complications associated with microvascular free fibula flap. Methodology: The study was conducted in the department of Burns, Plastic, Reconstructive and Microvascular surgery SKIMS Srinagar from DEC- 2012 to AUG- 2014.The patients undergoing mandibular reconstruction during this period were the subjects of study. Results: The study included 20 patients; there were 14 males and 6 females. The etiology of mandibular defect in 17 patients (85%) was post tumor excision, in 2 patients (10%) mandibular defect was secondary to fire arm injury and there was 1 patient (5%) of post bear maul mandibular defect. Primary reconstruction was done in 18 patients (90%) and reconstruction was secondary in 2 patients (10%). Osteocutaneous flap was harvested in majority of patients (90%), bone only flap was used in two patients (10%) The average length of bone flap was 10 cm (range 6cm to 14cm), skin paddle measuring an average of 12x6cm (range 8x6cm to 16x9cm) was transferred with bone flap in osteocutaneous flap. In majority of cases (18 patients) donor site was covered by split thickness graft, and in two cases donor site could be closed primarily. Functional result was good in sixteen patients (80%), fair in three patients (15%), and poor in one patient (5%). Cosmetic result was good in fifteen patients (75%), fair in four patients (20%), and poor in one patient (5%). Complications developed in three patients (15%). There was complete flap loss in one patient (5%) due to venous thrombosis. Skin paddle was lost in one patient (5%) but the bone flap survived. orocutaneous fistula developed in one patient (5%). Donor site morbidity was recorded in five patients (25%). Calf paresthesias developed in two patients (10 %), pain in lower leg developed in two patients (10 %), and there was partial graft loss at donor site in one patient (5%). Conclusion: The fibula osteocutaneous free flap allows the reconstruction of complex mandibular defects. It allows harvest of a long segment of bone, to reconstruct any length and part of mandible. Multiple osteotomies may be performed to achieve normal mandibular contour. The skin of the lower lateral leg is thin and pliable, with large amounts of skin available, allowing reconstruction of soft tissue defects in oromandibular region.