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DOI: 10.1055/s-0037-1604343
The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success?
Publication History
19 February 2017
11 June 2017
Publication Date:
01 August 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029352/201702/lookinside/thumbnails/10-1055-s-0037-1604343_17020008-1.jpg)
Abstract
Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction.
Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study.
Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001).
Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.
Keywords
free vascularized bone transfer - osteocutaneous free fibula flap - mandibular reconstructionNote
The content of this article has been seen, read, and agreed upon by all designated authors. This article has not been submitted or published elsewhere.
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References
- 1 Hanken H, Wilkens R, Riecke B. , et al. Is immediate bony microsurgical reconstruction after head and neck tumor ablation associated with a higher rate of local recurrence?. J Craniomaxillofac Surg 2015; 43 (03) 373-375
- 2 Papadopulos NA, Schaff J, Sader R. , et al. Mandibular reconstruction with free osteofasciocutaneous fibula flap: a 10 years experience. Injury 2008; 39 (Suppl. 03) S75-S82
- 3 Wolff KD, Ervens J, Herzog K, Hoffmeister B. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Craniomaxillofac Surg 1996; 24 (06) 330-338
- 4 Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience. Plast Reconstr Surg 2016; 137 (04) 1292-1305
- 5 Weitz J, Kreutzer K, Bauer FJ, Wolff KD, Nobis CP, Kesting MR. Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects. J Craniomaxillofac Surg 2015; 43 (09) 1769-1775
- 6 Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 1991; 117 (07) 733-744
- 7 Götz C, Warnke PH, Kolk A. Current and future options of regeneration methods and reconstructive surgery of the facial skeleton. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120 (03) 315-323
- 8 Hölzle F, Kesting MR, Hölzle G. , et al. Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps. Int J Oral Maxillofac Surg 2007; 36 (09) 802-806
- 9 van Gemert JT, van Es RJ, Rosenberg AJ, van der Bilt A, Koole R, Van Cann EM. Free vascularized flaps for reconstruction of the mandible: complications, success, and dental rehabilitation. J Oral Maxillofac Surg 2012; 70 (07) 1692-1698
- 10 Jewer DD, Boyd JB, Manktelow RT. , et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 1989; 84 (03) 391-403 , discussion 404–405
- 11 Rocha FS, Dias PC, Limirio PH, Lara VC, Batista JD, Dechichi P. High doses of ionizing radiation on bone repair: is there effect outside the irradiated site?. Injury 2017; 48 (03) 671-673
- 12 Brown JS, Lowe D, Kanatas A, Schache A. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55 (02) 113-126
- 13 Ducic Y. Intraoperative free flap monitoring using Indocyanine Green. JAMA Facial Plast Surg 2015; 17 (06) 427
- 14 Valerio I, Green III JM, Sacks JM, Thomas S, Sabino J, Acarturk TO. Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. J Reconstr Microsurg 2015; 31 (01) 45-53
- 15 Hölzle F, Loeffelbein DJ, Nolte D, Wolff KD. Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg 2006; 34 (01) 25-33
- 16 Trainotti S, Raith S, Kesting M. , et al. Locking versus nonlocking plates in mandibular reconstruction with fibular graft–a biomechanical ex vivo study. Clin Oral Investig 2014; 18 (04) 1291-1298
- 17 Kolk A, Jubitz N, Mengele K. , et al. Expression of Y-box-binding protein YB-1 allows stratification into long- and short-term survivors of head and neck cancer patients. Br J Cancer 2011; 105 (12) 1864-1873
- 18 Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Dtsch Arztebl Int 2012; 109 (48) 829-835
- 19 Pautke C, Bauer F, Bissinger O. , et al. Tetracycline bone fluorescence: a valuable marker for osteonecrosis characterization and therapy. J Oral Maxillofac Surg 2010; 68 (01) 125-129
- 20 Kruse AL, Luebbers HT, Grätz KW, Obwegeser JA. Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery 2010; 30 (03) 242-248
- 21 Schultze-Mosgau S, Grabenbauer GG, Radespiel-Tröger M. , et al. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region. Head Neck 2002; 24 (01) 42-51
- 22 Aitasalo K, Relander M, Virolainen E. Microvascular free tissue transfers after preoperative irradiation in head and neck reconstructions. Acta Otolaryngol Suppl 1997; 529: 247-250
- 23 Gürlek A, Miller MJ, Amin AA. , et al. Reconstruction of complex radiation-induced injuries using free-tissue transfer. J Reconstr Microsurg 1998; 14 (05) 337-340
- 24 Mulholland S, Boyd JB, McCabe S. , et al. Recipient vessels in head and neck microsurgery: radiation effect and vessel access. Plast Reconstr Surg 1993; 92 (04) 628-632
- 25 Miller MW, Dean NR, Cannady SB, Rosenthal EL, Wax MK. Free tissue transfer for head and neck reconstruction in solid organ transplant patients. Head Neck 2012; 34 (08) 1143-1146
- 26 Anthony JP, Ritter EF, Young DM, Singer MI. Enhancing fibula free flap skin island reliability and versatility for mandibular reconstruction. Ann Plast Surg 1993; 31 (02) 106-111
- 27 Sanger JR, Matloub HS, Yousif NJ. Sequential connection of flaps: a logical approach to customized mandibular reconstruction. Am J Surg 1990; 160 (04) 402-404
- 28 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84 (01) 71-79
- 29 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141