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 FIG. 17-18. Postoperative Panorex of rib graft in place.
 FIG. 17-19. Postoperative lateral view.
 FIG. 17-20. Frontal view shows fair restoration of contour. Symphysis of mandible is maintained in midline.
CASE 4
Following resection of a right mandibular fibrous histiocytoma, a 34-year-old woman had partial reconstruction of the mandible with an iliac crest bone graft, which required
removal secondary to infection.
 FIG. 17-21. After prolonged antibiotic therapy, a vascularized rib transplantation was planned. Preoperative view.
 FIG. 17-22. The seventh rib, transplanted with the overlying serratus muscle, was transferred to the mandible and revascularized by microsurgical anastomoses to the facial vessels. The preoperative markings show the thoracodorsal branch to the serratus muscle slips.
 FIG. 17-23. The rib was scored subperiosteally in three places to create the curve of the mandible.
 FIG. 17-24. Pre- and postoperative panorex views show the rib in place. Preoperative, above.
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 FIG. 17-25. The rib has restored an alveolar ridge.
 FIG. 17-26. Early follow-up shows excellent projection, but considerable soft tissue defect persists. Side view. In hindsight, the transfer of an additional slip of serratus muscle would have alleviated this problem. (From Whitney, T.M., Buncke, H.J., Alpert, B.S., Buncke, G.M., and Lineaweaver, W.C.: The serratus anterior free muscle flap: Experience with 100 consecutive cases. Plast. Reconstr. Surg. In Press, 1989.)
 FIG. 17-27. Front view.
References
1. Ostrup, L.T., and Fredrickson, J.M.: Distant transfer of a free living bone graft by microvascular anastomoses. Experimental study. Plast. Reconstr. Surg. 54:3, 1974.
2. Buncke, H.J., Fumas, D.W., Gordon, L., and Achauer, B.M.: Free osteocutaneous flap from a rib to the tibia. Plast. Reconstr. Surg. 59:799, 1977.
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