Revascularization of free mandibular reconstruction after early emergency arterial ligation

S. Bonawitz, A. K. Gosain, H. S. Matloub, D. L. Larson

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


A 70-year-old man with a squamous cell carcinoma involving the anterior arch and body of the mandible underwent resection and reconstruction with a 10-cm free vascularized iliac crest bone graft, preserving periosteum and minimal adjacent soft tissue. On postoperative day 12, he experienced bleeding from an orocutaneous fistula, requiring emergency ligation of the arterial pedicle to control hemorrhage. After ligation, continued bleeding was noted from the margin of the graft, with active filling of the venous pedicle. The 10-cm mandibular bone graft survived without appreciable resorption during a period of follow-up of 5 years. We believe that bone graft survival in the present case was due to early vascular communication between the periosteum and adjacent soft tissues of the graft with the recipient bed. This mechanism may serve to maintain bone graft viability after early arterial disruption, when repeat arterial anastomosis is believed to be contraindicated.

Original languageEnglish (US)
Pages (from-to)552-556
Number of pages5
JournalAnnals of plastic surgery
Issue number5
StatePublished - Nov 23 1994

ASJC Scopus subject areas

  • Surgery


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