Common Bony-Free Flaps in Maxillofacial Reconstruction

Microsurgical reconstruction in the maxillofacial region presents unique challenges due to the complexity of the anatomy and the need for both functional and esthetic restoration. Microvascular free tissue transfer offers a single-stage solution with sufficient soft tissue and/or bone for the reconstruction of complex head and neck defects. Bone reconstruction in the maxillofacial area should be a goal to achieve not only to restore craniofacial esthetics and functionality but also to create a suitable foundation for osseointegrated implants and subsequent dental prostheses when there is a significant loss of tooth-bearing segments. Among the most used techniques for maxilofacial bone reconstruction are the fibula (FFF), the scapula (SFF), and the iliac crest free flaps (ICFF). These methods provide versatile and appropriate options for the reconstruction of mandibular and maxillary defects, offering a reliable vascular supply, and sufficient bone length with the ability to incorporate soft tissue components. This chapter thoroughly describes the indications, advantages, and disadvantages, as well as the surgical technique of the most common bony free flaps in maxillofacial reconstruction.