Purpose: The management of composite oromandibular defects involving the posterolateral mandible and surrounding soft tissue remains a reconstructive challenge. While bony reconstitution restores continuity of the mandible, osteocutaneous flaps usually do not provide adequate soft tissue coverage of post-ablative defects. The purpose of this study was thus to evaluate the use of soft tissue flap reconstruction for extensive, posterolateral, oromandibular defects.

Methods: Consecutive patients who underwent reconstruction of composite oromandibular defects following posterolateral mandibulectomy between 1992 and 2006 at a single center were identified. Patient demographics, oncologic, reconstructive and outcome data was obtained from a prospectively-maintained clinical database. Medical records were retrospectively reviewed to further characterize the surgical extent of all post-ablative, soft-tissue defects. Soft-tissue resection zones were defined as those involving the: retromandibular trigone, palate, pharynx, floor of the mouth, tongue, cheek and lips.

Results: In total, 330 patients who underwent microvascular reconstruction following mandibulectomy were identified. Seventy-six patients (23 %) were further identified as having extensive, posterolateral, oromandibular defects reconstructed with soft-tissue flaps alone. The majority of these patients had a diagnosis of squamous cell carcinoma (n= 47); mean patient age was 59 years. In 68% of patients who underwent non-osseous free tissue transfer, the oromandibular defect involved °Ý 2 soft-tissue zones. (Table 1). The most common flap used was the vertical rectus myocutaneous flap (n = 68), followed by the anterolateral thigh (n = 4), the gracilis (n = 2) and the latissimus dorsi (n = 2). Overall flap survival was 96%; partial flap loss occurred in 6.6% of cases. Mean hospital stay was 17 days (range: 4-76). The most common peri-operative complication was infection (18%), followed by the development of orocutaneous fistulae (6.6%). At the time of discharge, 65% of patients were on an oral diet. Fifty-fix percent of patients who underwent subsequent speech evaluation had intelligible speech. Overall aesthetic outcome was good in 48%, fair in 22% and poor in 30% of patients.

Conclusions: Posterolateral mandibular defects with extensive soft tissue components can be effectively repaired using soft tissue flaps alone. In patients whose oromandibular defect involves the resection of >2 zones of surrounding soft-tissue, the vertical rectus myocutaneous flap can provide a large volume of soft-tissue for reliable wound closure. Function can be restored in the majority of patients. Similarly, in the majority of patients, fair to good aesthetic results can be achieved, especially in those without external skin defects.

Table 1.

	No. of Soft Tissue Zones  Resected During   Tumor Ablation	Patients   n = 76
1	25(32%)
2	22 ( 29%)
3	20 (27%)
4	7 (10%)
5	1 (1%)
6	1 (1%)