Secondary Mandibular Reconstruction with the Smallest Free Fibula Flap Following Comminuted Fracture - A Case Report

Abstract Rationale: Mandibular defects complicated by infection and non-union are a challenge to reconstruction and are associated with high failure rates with non-vascularised bone grafts. Patient Concerns: Exposed hardware and difficulty in chewing and speech articulation. Diagnosis: Previously operated case of comminuted mandibular fracture with fracture non-union and exposed implants. Treatment: Debridement of necrotic bone and exposed hardware with recreation of the defect (2.5 cm) and free fibula flap reconstruction for the same. Outcomes: The outcome was measured clinically by uneventful recovery with a well-settled flap, occlusion of the teeth, subsequent improvement in speech and swallowing and radiologically by the duration of bony union at the graft-host junction, which supports a dental implant. Along with this, the patient was also evaluated for UW-QOL (University of Washington, Quality of Life score). Take-away Lessons: Vascularized bone grafting is a valuable option for reconstructing bone defects during secondary reconstruction, even when the defect is small, particularly in cases complicated by infection and nonunion.