Pediatric mandible reconstruction using free iliac crest flap with growth center: flap growth assessment after long-term follow-up

Background Mandibular reconstruction in children is uncommon and implies specific concerns when compared to the adult patient, namely regarding long-term results and growth considerations. Vascularized or non-vascularized bone or cartilage flaps can be used. Commonly used bone-donor sites include fibula, iliac crest, and scapula, all of which with the possibility of including growth centers that can be theoretically used for a "growing bone" reconstruction. Methods We retrospectively evaluate a series of 6 pediatric patients who underwent mandibular reconstruction with iliac crest free flaps between 2005 and 2015 in our center. A sequential 3D analysis of the volume and dimensions of the bone-flap was done through time in order to evaluate the growth pattern of reconstructed bone. Results From January 2000 to January 2015, a total of 6 pediatric patients have had a mandibular defect reconstructed with free iliac crest flap. One was lost to follow-up and was not included in the study. After evaluation of flap dimensions and volume at early post-op and 5 years post-op, no significant increase in flap dimensions or volume was observed. No native mandible growth impairment was observed nor gross maxillo-mandibular deformity, with all the patients achieving an esthetically pleasant appearance. Conclusions Pediatric mandible reconstruction is a challenge for the reconstructive surgeon. Although flap growth was not observed in this series, overall facial symmetry was obtained during growth with no gross maxillo-mandibular deformity. Level of Evidence: Level IV, therapeutic study.