Journal of Surgery 2014; 2(6-1): 1-5 Published online June 09, 2014 (http://www.sciencepublishinggroup.com/j/js) doi: 10.11648/j.js.s.2014020601.11 ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online) Vascularized free fibula flap for reconstruction of mandibular defects Mohammad Akheel 1 , Suryapratap Singh Tomar 2 , Anuj Bhargava 3 1 Dept of Oral & maxillofacial surgery, NMCH, Nellore, India 2 Dept. of Neurosurgery, NMCH, Nellore, India 3 Dept of Oral & maxillofacial surgery, Index dental college, Indore, M.P., India Email address: drakheelomfs@gmail.com (M. Akheel), dr.suryapratap_singh_tomar@yahoo.com (S. S. Tomar) To cite this article: Mohammad Akheel, Suryapratap Singh Tomar, Anuj Bhargava. Vascularized Free Fibula Flap for Reconstruction of Mandibular Defects. Journal of Surgery. Special Issue: Craniofacial Surgery. Vol. 2, No. 6-1, 2014, pp. 1-5. doi: 10.11648/j.js.s.2014020601.11 Abstract: Objective: To assess the versatility of vascularized free fibula flap in reconstruction of various defects of mandible. Study Design: Prospective study. Duration of Study: March 2009 to March 2012. Methodology: The study group consisted of 10 patients who underwent resection of mandible for various reasons and reconstruction of continuity defects using a vascularized free fibular flap. The mandible was resected for ameloblastoma in 4 cases, squamous cell carcinoma in 1 case, odontogenic keratocysts in 3 cases and ossifying fibroma in 2 cases. The type of reconstruction performed was primary in 9 patients in which osseous fibula flap was used and secondary in 1 patient in which osseocutaneous flap was used. Results: There were 10 patients which include 5 males and 5 females within age group of 20 to 50 years with mean age of 35 years. All flaps survived except in 1 patient who had donor site morbidity. Flap perfusion was seen immediately after anastomosis and was maintained throughout the follow-up period of minimum 6 months. All patients were kept in nasogastric feeding for 5 days and then began oral feeding and walking with some aid in 2 nd week and became completely ambulant in 4 th week postoperatively. Conclusion: In our study, we conclude that vascularized free fibula flap is a versatile option for reconstruction of large mandibular defects with its good quality and quantity of bone and ease of manipulation to restore the original anatomy of the mandible and permit implant based prosthetic rehabilitation. Keywords: Fibula Reconstruction, Ameloblastoma, Odontogenic Keratocysts 1. Introduction Pathologies predisposing to wide resection of mandible pose a great surgical challenge for head and neck surgeon for reconstruction and rehabilitation. Various techniques of flaps have been used since years. The goal of reconstructive surgery following ablation of soft and hard tissue loss is to reconstruct the defect at the time of surgery primarily to facilitate a good wound healing and cosmetic outcome 1 . Reconstructive options for maxillofacial defects have improved tremendously beyond the primary closure, stainless steel reconstruction plates and skin grafts to a wide variety of pedicled flaps. More recently, due to advancements in surgical technique, improved knowledge in anatomy and various complications reported in literature, the surgeons have introduced the use of micro vascular free flaps to reconstruct the composite defects in order to match the resected tissues and provide a better quality of life 2, 3 . The pedicled flaps which are anastomosed represent unique principle of transplantation, being suitable for reconstruction of a variety of complex and large defects. Among the various flaps used, vascularized free fibular flaps are considered to be a workhorse since hidalgo has used it for mandibular reconstruction 4, 5, 6 . The vascularized free fibula flap provides a good quality bone graft with a low complication rate 7, 8 . Multiple osteotomies can be made to reform the exact orientation of resected mandible. The presence of thick cortical bone makes it easy to rehabilitate the patient with implant based prosthesis when compared to other flaps and hence represents the first choice for head and neck surgeons 4, 5 . The current study was designed to determine the results of using vascularized free fibular flap for reconstruction of mandibular defects.