Clinical Report: Complex Mandibular Reconstruction Using Fibula Free Flap

Overview

Complex mandibular reconstruction at Sentara EVMS involves a multidisciplinary surgical approach using patient-specific 3D planning and fibula free flap transfer. This technique restores mandibular structure and function while minimizing risks to surrounding tissues.

Background

Jawbone cancers often present with swelling, bleeding, or severe pain and may require surgical resection of portions of the mandible. Reconstruction is critical to restore mandibular integrity and function. Sentara EVMS Comprehensive Head and Neck Center employs advanced preoperative planning with CT imaging and 3D printing to customize reconstruction plates. The procedure involves harvesting a fibula free flap with skin and blood vessels to replace the resected mandible segment.

Data Highlights

Key procedural steps include:

• Preoperative CT scan and 3D printed patient-specific reconstruction plate
• Fibula free flap harvest with skin paddle and vascular pedicle
• Attachment of titanium plate to native mandible with surgical screws
• Insertion and fixation of fibula bone segment into mandible
• Soft tissue inset with watertight closure to prevent saliva leakage
• Microvascular anastomosis to recipient neck vessels (e.g., facial artery)
• Postoperative ICU stay of minimum 3 days, followed by surgical floor care
• Typical hospital discharge after approximately 1 week

Key Findings

• Use of rapid prototyping and 3D printing enables precise surgical planning and custom reconstruction plates.
• Fibula free flap harvest includes bone, skin paddle, blood vessels, and muscle for comprehensive reconstruction.
• Tourniquet use during fibula harvest limits blood loss while allowing revascularization post-harvest.
• Watertight closure of soft tissue is essential to prevent saliva leakage and infection risk.
• Microvascular anastomosis to facial artery ensures graft viability and successful revascularization.
• Postoperative care includes ICU monitoring and delayed oral intake to optimize healing.

Clinical Implications

This complex reconstructive approach highlights the importance of multidisciplinary coordination and advanced surgical planning to optimize outcomes in mandibular reconstruction. Ensuring precise bone and soft tissue placement with vascularized free flaps reduces complications and supports functional recovery. Postoperative management including ICU care and careful monitoring of graft viability is critical for successful healing.

Conclusion

Sentara EVMS’s specialized mandibular reconstruction using fibula free flaps and patient-specific 3D planning represents a state-of-the-art approach to restoring mandibular form and function after oncologic resection. This technique improves surgical precision and patient outcomes in complex head and neck cancer cases.

References

1. Sentara EVMS Comprehensive Head and Neck Center -- Complex Mandibular Reconstruction
2. BroadcastMed 2024 -- Complex Mandible Reconstruction with Free Tissue Transfer Surgical Video
3. Merck Manual Professional Version -- Jaw Tumors