Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Chang, Eric I.

doi:10.1002/hed.24796

Cited by 8 publications

(11 citation statements)

References 23 publications

(36 reference statements)

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“…Chang et al, analyzing a large series of fibula OSC flaps for mandible reconstruction, found that in all the flaps that underwent emergent re-exploration (due to venous thrombosis) the size of the pedicle vein was significantly larger than the size of recipient vein. 30 Another possible explanation for the high take-back rate might reside in the type of reconstruction accomplished with this flap. Nine fibula flaps (34.6%) were used in patients with osteoradionecrosis or reconstruction plate exposure.…”

Section: Discussionmentioning

confidence: 99%

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Ribeiro

Tsao

Hung

et al. 2022

J Reconstr Microsurg

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Background Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels. Methods We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels. Results A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates. Conclusion Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.

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Section: Discussionmentioning

confidence: 99%

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Ribeiro

Tsao

Hung

et al. 2022

J Reconstr Microsurg

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“…The fibula osteocutaneous flap is more prone to vascular thrombosis if ischemia is over 5 h (Chang et al, 2010). Moreover, the most common reason for flap failure is vascular compromise (Chang et al, 2016; Fukuiwa et al, 2008; Kaciulyte et al, 2019; Yu et al, 2009) Although venous thrombosis is observed more frequently compared to arterial thrombosis, it is usually associated with a higher salvage rate (Chang, 2017; Kruse et al, 2010). Venous thrombosis occurred primarily because of a mechanical obstruction due to compression; such as kinking, twisting or hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Venous thrombosis occurred primarily because of a mechanical obstruction due to compression; such as kinking, twisting or hematoma. Therefore, swift correction of the mechanical cause led to a higher salvage rate compared artery‐caused failures (Chang, 2017; Yu et al, 2009). Twisting or kinking of the pedicle due to the acute angle between the pedicle and fibula axis were encountered more frequently than a hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…The increased overall velocity decreases the risk of vascular thrombosis. Therefore, a vascular compromise was to happen it should be expected in the first two critical days after surgery (Chang, 2017; Hanasono et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding its complexity, the loss of the fibula osteocutaneous flap may have devastating results for both form and function. According to previous studies, the major contributor to fibula flap loss is vascular compromise, specifically, venous thrombosis (Chang, 2017; Chang et al, 2016; Fukuiwa et al, 2008; Wu et al, 2014; Yu et al, 2009). The most meaningful way for salvaging the flap is immediate exploration.…”

Section: Introductionmentioning

confidence: 99%

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Three salvage strategies in microvascular fibula osteocutaneous flap for mandible reconstruction with vascular compromise and establishment of an algorithm

et al. 2021

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Background Fibula osteocutaneous flap is associated with a higher rate of reexploration in mandible reconstruction due to limited space for the fixation of various tissue components on multiple segments of the fibula flap. To maintain optimal circulation to the flap and to prevent negative outcomes because of partial or total flap loss, we shared our experiences on salvaging the free fibula flap with vascular compromise in the first reexploration and we developed an algorithm. Methods From 1992 to 2018, 12 patients between the ages of 48 to 63 (mean: 52.5) who had presented with oral squamous cell carcinoma (n = 10) followed by osteoradionecrosis of the mandible (n = 2) were explored. The operative findings were; (1) occlusions of vein (3 cases); (2) occlusions of artery (4 cases); and (3) occlusions of both artery and vein (5 cases). After correcting the kinking or evacuating the hematoma, the arterial inflow was initially reestablished by anterograde flow. If this was nonfunctional, retrograde flow from the distal end of the peroneal artery was provided. For the vein, anterograde venous drainage was reestablished. If the thrombus extended deep into the peroneal vein, regular venous return was blocked on the anterograde side, and the flap remained congested therefore retrograde venous drainage was performed regardless of the valves in the vein. However, the two ends of the peroneal artery were anastomosed to prevent thrombosis of the artery. Results The success rate of revised cases was 75% (9/12). All failed cases had presented with both artery and vein occlusion (three cases). Pectoralis major musculocutaneous flap and anterolateral thigh flap were needed for the external surface in two cases. Skin graft was required for seven cases to restore intraoral lining. Six patients underwent dental rehabilitation with prosthetic implants. Conclusion Immediate reexploration is mandatory to salvage the flap.

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Recipient Vessels: Radius Reconstruction

Aksoyler

Chen

2021

Recipient Vessels in Reconstructive Microsurgery

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Impact of venous outflow tract on survival of osteocutaneous free fibula flaps for mandibular reconstruction: A 14‐year review

Abstract: Venous thrombosis of free fibula flaps is more common than arterial thrombosis. Venous stasis in larger vena comitantes may be a contributing factor to microvascular compromise. Anticoagulation and/or handsewn anastomosis may be beneficial if the veins are larger than 4.0 mm in size.

Cited by 8 publications

References 23 publications

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Three salvage strategies in microvascular fibula osteocutaneous flap for mandible reconstruction with vascular compromise and establishment of an algorithm

Recipient Vessels: Radius Reconstruction

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