Microvascular Craniomaxill of acial Reconstructive Bone Surgery

The ability to reconstruct defects with free tissue has dramatically improved the outcomes of patients with deficits of the head and neck. These vascularized bone grafts (VBGs) have dramatically improved the potential for reconstruction of complex defects of the mandible and maxilla following tumor ablation or severe trauma. VBGs utilizing microvascular free tissue transfer are at the top of the reconstructive ladder, providing vascularized tissue to defects of substantial size or suboptimal conditions such as areas of radiation, infection, and implantation. These flaps may be used for defects in the maxilla and/or mandible, depending on the defect’s size, location, and local tissues required. Numerous donor sites for free bone flaps have been described for this application, including the fibula, iliac crest, scapula, rib, and radial forearm. In addition to a comprehensive discussion of each, current and future trends in the field, such as CAD-CAM imaging, robotic surgery, and tissue engineering, are described in the present chapter.