Jgaflac,

Just to add what Christine already said, I had this surgery, mandibulectomy with a fibula free flap, for ORN in September 2016. I had two areas, the ramus and body of the mandible being replaced. There was talk about using the scapula due to difficulty walking, but I opted for the fibula being its the workhorse used for this surgery, and is less bulky for my areas.

Before my surgery, I had a MRA of the legs to check the vessels if they were good enough to be used. They also asked what your shoe size was because you will need a leg boot for a while to take some of the weight off the leg where the fibula is removed. Also, due to the amount of radiation, and prior surgeries I had, I'm vessel depleted in my left neck, so there isn't anything to attach the Fibular to. As such, they took the internal mammary artery and vein by cutting through the ribs, and attached them to the fibula for blood supply, and used the calf tissue for a skin paddle to close the neck due to the fibrosis already present. This can happen in prior radiated patients too where the vessels are too compromised.

The surgery was 8 hours done by my ENT, who did 3 of my other surgeries, and a Plastic Surgeon. I hardly recall being in recovery, but what little communication I had was difficult, had a trache, and even though I had asked if they were going to have a writing board beforehand they didn't, plus I was alone my entire stay. Somehow I managed to get across I would like a writing board, and that was pretty difficult to use and make sense anyway. I did have ispeak on my iPhone, but I didn't have my personal bag yet, and when I did have it the next day, my vision was so off I didn't use it, then it wasn't needed.

My ENT said they didn't like to put patients in ICU, and was in the step down unit, like my other surgeries, for 6 days. Somehow my writing board was misplaced during the transfer to step down, and had fun doing sign language to get one. During my stay, they checked flap with a small ultra/sound for blood flow, my leg too i believe every hour. They liked to keep you warm too for healing too.

About the 3rd day they had you out of bed sitting in a chair. The trache, which had a humidifier attached, was taken out about the 4th day, and so was the nasal tube since I no longer had a peg feeding tube to use. About that time, my ENT put in a hands free speaking valve in too, which was removed that week, and was eating soft food about that time too.

There were no plans to go into rehab, but I was already physically impaired, and didn't want to burden my mother 81 year old mother, so I did go into rehab for 2 months, which I probably needed even before my surgery.

The trache stoma was slow in closing, probably due to prior radiation, It took a month to finally close, so that needed constant attention,covering when speaking, and somehow was leaking food, possibly aspiration or a fistula.

I probably had the boot more than necessary since it was used more to protect my donor leg site, which had healing trouble for 6 months, and needed contestant care. A re-graft, pinch graft, was taken from the groin to cover the leg donor site. The thigh graft site used to close the donor site seemed to heal accordingly, but it takes a while.

About 3 months I had PET/CT, I was due for one, instead of just a CT to check the jaw bone integration.

The jaw bone and rib cage have titanium plates. It wasn't until the winter that I had severe jaw pain, which I found out can happen with the metal plates, so I look like a ninja when I walk outside for any length of time.

I was going to have reconstruction for my mouth since the jaw nerve is cut during surgery, and debulking the neck with the calf tissue, in August, almost a year out, but was canceled because I have to be on blood thinners for a year due to a heart attack in June with a stent.

I hope this helps, and good luck.