Surgical Mandible Reconstruction Using a Microvascular Graft | University Hospital Rechts der Isar Munich

The University Hospital Rechts der Isar of the Technical University of Munich stands at the global forefront of reconstructive surgery, offering a definitive solution for patients facing extensive jawbone loss due to trauma, tumor resection, or congenital conditions. Surgical mandible reconstruction using a microvascular graft represents the absolute pinnacle of oral and maxillofacial expertise, blending high-stakes microsurgery with artistic facial restoration. Unlike traditional bone grafting, which relies on the body to gradually incorporate a static piece of bone, the microvascular approach involves transplanting living tissue, complete with its own dedicated blood supply, directly into the defect site. This technique, often referred to as a free flap procedure, ensures the highest possible success rate for long-term integration and provides a robust foundation for future dental implants and functional rehabilitation. The intricate process begins with a sophisticated preoperative phase in which our surgeons use high-resolution 3D imaging and virtual surgical planning to create a digital twin of the patient’s anatomy. During this stage, we precisely map out the vascular anatomy of the donor site, typically the fibula from the lower leg, the scapula from the shoulder, or the iliac crest from the hip. By using 3D-printed cutting guides tailored to the patient’s unique skeletal structure, our surgeons can pre-shape the donor bone with millimeter-precision before it is even harvested. This level of technological integration ensures that the reconstructed mandible will perfectly mirror the patient’s original facial proportions, maintaining the natural contour of the chin and jawline while restoring the vital structural integrity needed for speech and mastication. The surgical execution at TUM University Hospital is a masterclass in multidisciplinary collaboration, often involving two surgical teams working simultaneously to minimize time under anesthesia. While one team prepares the recipient site in the jaw, the other carefully harvests the graft along with its essential artery and vein. The defining moment of the procedure occurs under a high-powered surgical microscope, where our specialists perform delicate microvascular anastomoses, suturing blood vessels thinner than a strand of hair to reconnect the graft’s circulation to the vessels in the neck. Once the blood flow is restored to the transplanted bone, it becomes a living part of the face, capable of healing, remodeling, and resisting infection far more effectively than any synthetic or non-vascularized alternative. Recovery and rehabilitation at our Munich facility are managed through a comprehensive, integrated care pathway that supports both donor and recipient sites. Patients are monitored in a specialized intensive or intermediate care setting, where the graft's vitality is checked hourly using advanced Doppler technology to ensure optimal perfusion. As healing progresses, our dedicated team of physiotherapists and speech therapists begins working with the patient to restore mobility and function. Because the University Hospital Rechts der Isar is a leading research institution, patients benefit from the latest evidence-based protocols in pain management and wound care, ensuring a smooth, efficient transition from the operating room back to daily life.