Post‐operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps

Abstract

Educational Objective Assess outcomes of pediatric facial reconstruction with fibula free flaps. Objectives Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post‐operative complications, donor site morbidity, impact on craniofacial growth, and oro‐dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps. Study Design Retrospective chart review. Methods Multi‐institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps. Results Eighty‐seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long‐term hardware exposure, greater than 3 months following reconstruction. Short‐term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long‐term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long‐term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post‐operative speech outcomes showed 94% with fully intelligible speech. Conclusion Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long‐term follow‐up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post‐operative gait abnormality is rare. Level of Evidence 3 Laryngoscope, 133:302–306, 2023

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

“…The safety and efficacy of fibula free flap reconstruction for pediatric maxillomandibular defects was recently evaluated in multi-institutional retrospective study by Slijepcevic et al 28 Pre and post-operative chemotherapy did not appear to affect long-term wound healing in pediatric maxillomandibular reconstruction using a FFF, with minimal instances of hardware exposure reported. 28 Post-operative complications within 30 and 90 days occurred in less than 10% to 20% of patients, with only 1 free flap failure reported, with donor site complications occurring in less than 10% of patients. Dental rehabilitation was completed in a third of patients, and long-term craniofacial growth abnormalities occurred in a quarter of patients.…”

“…However, patients who had dental implantation at the time of fibula reconstruction did not demonstrate long-term craniofacial asymmetries or disturbances of maxillomandibular growth. 28 While functional outcomes such as speech and oral competency are independent of dental implantation, immediate dental implantation may be important for long-term facial growth outcomes and may be indicated before skeletal maturity is realized.…”

Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

“…Nevertheless, both FFF and ICF procedures carry the risk of vascular embolism, flap necrosis, and postoperative complications in the donor area, which may reduce the patient’s quality of life. According to recent research, individuals who receive either FFF or ICF procedures may have reduced joint range of motion, sensory impairments in the donor site, loading pain, and limited movement following surgery [ 18 – 20 ]. In contrast, posterior iliac cancellous bone can be utilized as a donor site in maxillofacial reconstruction, especially when restoring alveolar height deficits [ 21 ].…”

Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

“…Both FFF and ICF procedures carry the risk of vascular embolism, ap necrosis, and postoperative complications in the donor area, which may harm the patient's quality of life. According to recent research, individuals who receive either FFF or ICF procedures have been found to commonly experience a reduced joint range of motion, sensory impairments in the donor site, loading pain, and limited movement following surgery [15][16][17]. However, iliac cancellous bone is widely used as a donor site for correcting maxillofacial bone defects, especially posterior iliac bone [18].…”