Osteocutaneous Flaps in the Reconstruction of War Injuries of the Mandibula

During the civil war in ex-Yugoslavia, a large number of patients was treated at our clinic for injuries to the lower third of the face.Approximately, one third of them required reconstruction of large and small bone and soft tissue defects of the mandibula. The incidence of war injuries of the maxillofacial structures from 8% to 17%, according to the literature (1). In the ex-Yugoslavia civil war the percentage was 10% (2). Since 1993, we have been using free flap reconstruction for large defects of the lower third of the face: scapular, radial, forearm and fibular. Microsurgical free flaps have been extensively used in the reconstruction in this region (3, 4). A growing body of evidence suggests that microvascular osteocutaneous free tissue transfer is the most sophisticated method to reconstruct composite defects of the lower third of the face (5). In peace time, it is also one of the most reliable methods ranges to perform surgery in a single act for tumor ablation in the distal portion of the face, with immediate mandibular reconstruction. The purpose of this study was to demonstrate the results with microvascular free osteocutaneous flaps in the reconstruction of mass mandibular defects and facial soft tissue defects caused by war injuries.