Revisiting Myocutaneous Flaps as a Reliable Option for Reconstruction of the Oromandibular Region: An Algorithmic Approach

Objective: Reconstruction of extensive, composite oromandibular defects using osteocutaneous free flaps has become the gold standard procedure over the past two decades, although such reconstruction is associated with severe morbidity in certain patients. In such patients, soft-tissue flaps may be a better option, being associated with less donor-site morbidity but acceptable functional results. Methods: Seventeen patients were followed up for at least two years. Patients with mid-anterior segmental mandibular and posterior mandibular defects, who underwent reconstruction using boneless, pedicled or free myocutaneous flaps were evaluated in terms of flap failure and overall morbidity. Results: Five of 7 patients in the pedicled flap group and six of 10 in the free flap group had comorbid diseases that were both severe and more numerous in the pedicled flap group. Four of 17 patients lacked a significant clinical sign affecting the surgical choice. In seven patients, primary reconstructions using pedicled or free flaps were performed. In 10 cases, the reconstructions were salvage procedures. Tumor recurrence or osteoradionecrosis developed in six of the 17 cases. The complication rates were 5/7 in the pedicled flap group and 3/10 in the free flap group. Conclusion: Soft tissue flaps are a suitable option that can be used in posterior and/or posterolateral defects in primary reconstruction or secondary salvage procedures.