Vascularized rib-periosteal and osteocutaneous reconstruction of the maxilla and mandible: an assessment.

Three approaches to provide rib-periosteal or osteocutaneous composite tissue in maxillary or mandibular reconstruction are presented. All methods appear to be useful in replacing viable osteocytes and improving vascularity of maxillary or mandibular defects. Disadvantages include the bulk of the transplanted tissue, volume deficiency of bone, and the unreliability in viability of the associated cutaneous tissue, especially with the posterior and posterolateral approach. Significant patient morbidity and pulmonary complications in our series should indicate caution when considering these methods of reconstruction. At present, rib-periosteal transplantation is most often indicated to replace segmental defects of mandibular continuity when the recipient bed is avascular but the quantity of cutaneous cover is adequate. In those patients with deficient soft tissue and a small segmental mandibular loss, reconstruction with musculocutaneous flaps and nonvascularized bone grafts is indicated. With extensive deficiencies of both soft tissue cover and mandibular or maxillary continuity, an iliac osteocutaneous flap based on the deep circumflex iliac vessels may be the most effective. Lower patient morbidity statistics should be anticipated.