Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap

Abstract

Background Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect.

Methods A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups.

Results A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups (p < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF (p < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups (p < 0.05). The overall rate of complications was comparable between groups (24%, p = 0.129).

Conclusion The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.

Keywords

fibula - head and neck neoplasms - reconstructive surgical procedures - postoperative complications - surgical flaps

Thesis

The present article is not part of a thesis for a degree such as a Master's or PhD degree.

Presentation

This article has not been presented in a national or international meeting.

Authors' Contributions

(1) Conceptualization: All authors; (2) Data curation: all authors; (3) Formal analysis: all authors; (4) Funding acquisition: S.M.; (5) Investigation: all authors; (6) Methodology: all authors; (7) Project administration: all authors; (8) Resources: all authors; (9) Software: all authors; (10) Supervision: S.M.; (11) Validation: all authors; (12) Visualization: all authors; (13) Writing – original draft: all authors; (14) Writing – review and editing: all authors.

Publikationsverlauf

Eingereicht: 21. Juni 2022

Angenommen: 28. Februar 2023

Accepted Manuscript online:
23. März 2023

Artikel online veröffentlicht:
02. Mai 2023

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