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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2017; 02(02): e103-e110
DOI: 10.1055/s-0037-1604343
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success?

Andreas Kolk
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
S. Haidari
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
K.-D. Wolff
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
A. M. Fichter
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
V. Kehl
2   Department of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
,
C. Götz
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
M. R. Kesting
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
,
J. Weitz
1   Department of Oral and Maxillofacial Surgery, Technical University of Munich, Munich, Germany
› Institutsangaben
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Publikationsverlauf

19. Februar 2017

11. Juni 2017

Publikationsdatum:
01. August 2017 (online)

Auch verfügbar auf
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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 reconstruction

Note

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.


 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Ducic Y. Intraoperative free flap monitoring using Indocyanine Green. JAMA Facial Plast Surg 2015; 17 (06) 427
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Wolff KD, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Dtsch Arztebl Int 2012; 109 (48) 829-835
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 28 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84 (01) 71-79
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar