Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients

Abstract

This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007–2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046–15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120–20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.

Safe Free Tissue Transfer in Patients Older than 90 Years

“…There are varying reports of both higher and lower complication rates in bony flaps compared with soft tissue flaps in the literature, but interestingly, Frederick at al 25 in 2014 reported lower complication rates with fibula free flap transfer in general, at 2.9%, but this rate more than doubled to 6.3% in patients who underwent reconstruction for ORN rather than for oncologic ablation. [34][35][36] In our series, we have seen a significantly higher complication rate for patients receiving fibulae for reconstruction after ORN, at 100% (►Table 3), but this may be due to the elderly patient population used for this analysis having a higher rate of medical comorbidities. Regardless, there is insufficient literature to answer the question of whether patients receiving osteocutaneous free flaps consistently suffer a higher complication rate if ORN is involved when compared with resection of a primary tumor.…”

Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case–control study

“…reported 20 secondary mandibular reconstructions using FFF in patients with head and neck cancer. They demonstrated its advantages of lesser postoperative complications, such as recipient site infections and plate exposures, by comparing it with 41 secondary mandibular reconstructions using free soft tissue flaps combined with a bridging plate [ 12 ]. In both reports, the drawback of secondary mandibular reconstruction was the occurrence of scarring in recipient vessels and surrounding skin-soft tissues.…”

Safety and Efficacy of Secondary Mandibular Reconstruction Using a Free Osteo-cutaneous Fibula Flap after Segmental Mandibular Resection: A Retrospective Case Control Study

“…In India, Kadam et al performed secondary mandibular reconstructions using FFF in 21 patients and reported ap survival and an improvement in symptoms that had necessitated secondary reconstruction in all patients [10]. In Taiwan, Lin et al reported 20 secondary mandibular reconstructions using FFF in patients with head and neck cancer and demonstrated its advantages of lesser postoperative complications, such as recipient site infections and plate exposures, by comparing it with 41 secondary mandibular reconstructions using free soft tissue aps combined with a bridging plate [11]. In both reports, the drawback of secondary mandibular reconstruction was the occurrence of scarring in recipient vessels and surrounding skin-soft tissues.…”