Oromandibular reconstruction with double‐skin paddle fibular free flap: A systematic review and meta‐analysis

Abstract

Background Reconstruction of complex head and neck defects is challenging, especially when more than one soft‐tissue subunit is involved. The osteocutaneous fibular flap underwent continual evolution to improve its soft‐tissue characteristics, such as including a second skin island. The purpose of this study was to evaluate outcomes regarding oromandibular reconstruction with a double‐skin paddle fibular free flap (DSPFFF) using three different techniques: central de‐epithelialized skin paddle, distally‐based double‐skin paddle (DSP), or proximally and distally‐based DSP. Methods A systematic review was performed in December 2020 using Pubmed and MedLine Ovid databases according to the PRISMA guidelines. A meta‐analysis of functional outcome and complications was performed to estimate single incidence rates. Results A total of 449 patients were included, with a follow‐up of 1–84 months, where 330 patients underwent reconstruction with the first technique, 23 patients with the second technique, and 96 patients with the third technique. The meta‐analysis showed an overall good functional outcome and a low‐complication rate for oromandibular reconstruction with DSPFFF. A better functional outcome and a lower complication rate were found when a distally‐based DSPFFF was harvested compared to a proximally and distally‐based DSPFFF. Conclusion The DSPFFF was found to be useful and reliable for reconstructing composite and extensive head and neck defects, with an overall good functional outcome and a low‐complication rate. The meta‐analysis showed a better positive outcome on distally‐based DSPFFF rather than proximally and distally‐based DSPFFF. In addition, distally‐based DSPFFF showed a lower complications rate when compared with proximally and distally‐based DSPFFF.

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

“…25 In fact, a recent meta-analysis has shown superior outcomes of this technique when used for composite oromandibular defects. 7 On the other hand, the division of the skin paddle using a proximal muscular perforator provides the most convenient design for complex 3dimensional defects. The location and length of this musculocutaneous perforator allow to covering defects in different locations and an easier inset of the skin paddles without intertwining or tethering their blood supply (Figure 3) .…”

“…The location and length of this musculocutaneous perforator allow to covering defects in different locations and an easier inset of the skin paddles without intertwining or tethering their blood supply (Figure 3) . 7,19 Even if the number and location of perforators allow for div-FOCFF, in some instances splitting the skin paddle can be complicated when a large segment of bone is needed and dissecting the perforators off the fibula can cause injury or tension of the perforators. In this setting, using a deEpi-FOCFF may be preferred.…”

“…5,6 Despite the advantageous nature of the aforementioned approach, an additional set of anastomosis and multiple donor sites increase the overall operative time and morbidity index of the reconstructive procedure. 7 Hidalgo's demonstration of the versatility of the fibula osteocutaneous free flap (FOCFF) for mandibular reconstruction and subsequent modifications to improve the flap configuration, have established this flap as the gold standard treatment approach. 7,8 A double-skin paddled FFOCF, either crafted after de-epithelializing a central portion of the skin paddle (deEpi-FOCFF) or after dividing the skin paddle based on the perfusion of independent perforators (div-FOCFF), has further evidenced the prominent role of the FOCFF to address such composite defects in aggravated surgical settings (multiple facial subunits requiring reconstruction and/or This article is protected by copyright.…”

“…depleted vessel region). 7 Herein, the aim of this study was to present our experience using the FOCFF for reconstruction of through-and-through oromandibular defects, and compare the surgical outcomes and complications of different techniques for external skin coverage.…”

“…7 Hidalgo's demonstration of the versatility of the fibula osteocutaneous free flap (FOCFF) for mandibular reconstruction and subsequent modifications to improve the flap configuration, have established this flap as the gold standard treatment approach. 7,8 A double-skin paddled FFOCF, either crafted after deepithelializing a central portion of the skin paddle (deEpi-FOCFF) or after dividing the skin paddle based on the perfusion of independent perforators (div-FOCFF), has further evidenced the prominent role of the FOCFF to address such composite defects in aggravated surgical settings (multiple facial subunits requiring reconstruction and/or depleted vessel region). 7 Herein, the aim of this study was to present our experience using the FOCFF for reconstruction of through-and-through oromandibular defects, and compare the surgical outcomes and complications of different techniques for external skin coverage.…”