Augmentation of the atrophic mandible with a vascularized rib graft.

A patient with a 29-year history of denture wearing had her mandible augmented with a vascularized rib graft. The rib was contoured to fit the arch of the mandible and vascularized by means of the facial arteries to the intercostal vessels. The nutrient artery was not included in the vascularized bone graft. Cortical cancellous bone chips were packed around the rib to augment the buccal surface of the rib graft. Periosteal perfusion and vascularity of the transferred rib were well documented at 1 week, 1 month, and 6 months postoperatively by radionuclide scintigraphy. It is now 24 months after surgery and the patient began wearing a denture 2 months after the rib transfer. She underwent a split-thickness skin graft vestibuloplasty and floor-of-the-mouth lowering 12 months following the rib transfer with improvement in her denture-wearing capabilities, which has remained constant for 10 months. Vertical resorption of the graft at 3 months was 10 percent, at 6 months 15 percent, and it has stabilized at 25 percent.