• T Shpitzer, P C Neligan, P J Gullane, B J Boyd, E Gur, L E Rotstein, D H Brown, J C Irish, and J E Freeman.
• Division of Plastic Surgery, The Toronto Hospital, General Division EN 10-236, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
• Head Neck. 1999 Oct 1; 21 (7): 639-47.

BackgroundA variety of free flaps have been successfully used for mandible reconstruction. This study compared the short- and long-term results of using the free iliac crest and fibula flaps.MethodsWe conducted a retrospective analysis of 117 patients who underwent mandibular reconstruction, 59 patients with iliac crest and 58 with free fibula. Accurate long-term functional assessment was possible in 31 cases in the iliac crest group and in 48 patients with fibular reconstruction. Anterior or combined anterolateral defects formed 72% and 64% in the iliac crest and fibula groups, respectively. The remainder were pure lateral defects. In both series, a skin paddle was included to provide either lining, skin cover, or both in 77% of the cases, whereas in 23% bone only was used.ResultsComplications included two perioperative deaths and three flap losses in the iliac crest group and five flap losses in the fibula group. Long-term functional and cosmetic assessment showed no statistically significant differences in oral continence (p > 0.9), speech (p = 0.57), and contour results (p = 0.80) between the two groups. However, oral deglutition was statistically significantly better in the fibula free flap group (p = 0.009).ConclusionAlthough the fibula free flap is the flap of choice, the iliac crest is an excellent and reliable complementary flap for mandibular reconstruction.Copyright 1999 John Wiley & Sons, Inc. Head Neck 21: 639-647, 1999.

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