Reconstruction of the mandible with vascularized iliac crest flap--initial experience at the Tata Memorial Hospital.

Overview

Resection of the mandible for cancer of the oral cavity can result in gross functional and aesthetic deformity. Inspite of technological advances, reconstruction of mandibular defects remains one of the most challenging procedures in head and neck surgery. Conventional methods like alloplastic implants and bone grafting have a high rate of failure. The advent of microvascular techniques for mandibular reconstruction has revolutionised the management of these patients. We present our initial experience based on 18 patients who underwent vascularised iliac creast transfer at the Tata Memorial Hospital between November, 1992 and January, 1994. The operative technique of raising, shaping and fixation of the iliac crest flap as well as advantages and disadvantages are discussed. Postoperative graft viability was assessed using 99mTc-MDP scans during the 1st, 3rd and 12th weeks after surgery. We lost 3 flaps (16.4%) due to uncontrolled infection and vessel thrombosis. All of the remaining patients demonstrated good uptake on bone scans and satisfactory bony union on OPG. We conclude that mandibular reconstruction using the vascularised iliac crest is reliable and produces acceptable postoperative functional results with 88% of patients having no swallowing difficulty, 83% with normal speech and excellent cosmesis in 83% (15/18) of the patients.