Reconstructing Segmental Mandibular Defects: A Single-Center, 21-Year Experience with 413 Fibula Free Flaps

Background: The fibula free flap (FFF) is a common choice for mandibular reconstruction after post-oncologic resection. Advances in technology and surgical technique have changed the workflow of FFF-based mandible reconstruction. This study characterizes the institutional experience with these changes and their impact on patient outcomes. Methods: A 21-year retrospective review was performed of patients who underwent segmental mandibulectomy with FFF-based reconstruction. Results: 401 patients underwent reconstruction with 413 free flaps with a median follow-up period of 2.9 years. Over the study period, there was an upward trend in case volume with an average procedure length of 675.6 ± 132.5 minutes. Mini-plates (n=340, 82.3%) were most commonly used for flap fixation, but reconstruction bars (n=73, 17.7%) later became the preferred fixation method. 168 (40.7%) patients had surgical planning with computer-aided design and manufacturing (CAD/CAM). 98 (23.7%) patients underwent immediate dental implant placement (IDIP). As CAD/CAM and IDIP became more prevalent during the study period, dental rehabilitation rates increased. 226 (54.7%) patients experienced a complication at the recipient site, of which 122 (29.5%) required operative management; the rate of complications showed no discernable trend during the study period. The overall flap success rate of this cohort was 97.8% with an all-cause mortality rate of 43.6%. Conclusion: This study presents an institutional series of FFF-based mandible reconstruction in the 21 st century. Advances in surgical technique and technology have improved operative workflow and patient outcomes; however, post-oncologic mandible reconstruction remains a highly morbid procedure.