The Application Of Vascularized Free Fibula Flap In Reconstruction Of Mandibular Segmental Defects Depending On The CAD/CAM

Objective:The purpose of this study was to make a summary of vascularized free fibula flap as a new method for mandibular reconstruction.Methods:10 cases(7 male to 3 female) with mandibular segmental defects caused by different reasons,who have received mandibular reconstruction with flee vascularized fibular flaps from June 2007 to April 2009 at our department were studied retros-pectively. The patients scan with CT and reconstructed 3-dimensional mandibular images before operation.Simulated models which were similar to their own mandibles were made.According to the models,the design of vascularized flee fibula flap and the titanium palate were prepared.The operation applied vascular anastomosis,and the contour and the integrality of the mandible were covered by strong internal fixation.8 cases received free fibula flap,2 cases received fibula musculo cutaneous flap.7 cases received continuous fibula flap,3 cases received double barrel fibula flap.Evaluate the function and contour of the donor and recipient area.Results:1 flap suffered local necrosis,which healed by change dressings.All flaps were survival,and the wounds of donor area were primary healing.All patients walked normally,with no ankle unstability.The shape of faces were symmetry,with the gape degree more than 2 fingers.X-ray,CT and ECT showed right position and height coincidence to preoperative design,with good blood supply.Conclusions:CAD/CAM techniques have important value for mandible reconstr-uction in selection of donor site,planning of operation and shaping of fibula flap.The fibula flap could be cut into segments and shaped according to the location and shape of mandibular defects.The application of templates made the fibula flaps placed precisely by titanium palate.The fibular free flap has a good blood supply,strong resistance infection,quick bone healing,high survive rate,good plasticity and high density of cortical bone.There is enough bone available to reconstruct mandible defect.It's an ideal selection for the reconstruction of mandibular defects.