“20-year experience with 202 segmental mandibulectomy defects: A defect classification system, algorithm for flap selection, and surgical outcomes”

Background: This study establishes a novel and broadly-applicable defect classification system and flap selection algorithm for segmental mandibulectomy defects that emphasize the importance of the soft tissue deficit, in addition to that of the bony defect. Methods: Between 1992 and 2011, 202 patients with mandibulectomy defects underwent immediate reconstruction by a single surgeon. Details of the bony and soft tissue defects, recommendations for the most appropriate reconstruction for each clinical scenario, and surgical outcomes are presented. Results: A total of 211 flaps were performed in 202 patients. Forty-one (19%) were non-osseous only, and 170 (81%) were osseous-containing. The majority of osseous flaps were fibula osseous or osteocutaneous flaps (91%), and the majority of non-osseous flaps were vertical rectus abdominis myocutaneous (VRAM) flaps (68%). Flap selection was influenced by the number of soft tissue zones resected; defects of ≤1 soft tissue zone were predominantly reconstructed with an osseous flap, whereas defects that involved ≥4 zones underwent reconstruction with only a soft tissuey flap in 55% of cases. Conclusion: The algorithm for reconstruction of the mandibulectomy defect must include both non-osseus and osseus flaps based on defect size, location, and number of soft tissue zones involved. As the extent of the soft tissue defect increases, non-osseus flaps are preferred due to greater reliability of the skin island. The surgical outcomes associated with this algorithm are similar to or better than what is published in the literature. This series represents the largest reported single surgeon experience with mandibulectomy defect reconstruction. Financial Disclosure Statement: The authors have nothing to disclose. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Presented at: none Corresponding author: Peter G. Cordeiro, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, MRI 1007B, New York, New York 10065, Phone: 212-639-3099, Fax: 212-717-3677, Email: cordeirp@mskcc.org ©2017American Society of Plastic Surgeons