Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Abstract

Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

Superficial Temporal Artery and Vein as Alternative Recipient Vessels for Intraoral Reconstruction With Free Flaps to Avoid the Cervical Approach With the Resulting Need for Double Flap Transfer in Previously Treated Necks

“…This study investigated two very complex reconstructive options in a highly challenging patient population. In particular, the combination of a preoperated and irradiated neck reduces the reconstruction options to free microvascular flaps and may jeopardize the success rate of free tissue transfer as well as increase the complication rates ( 1 , 26 ). Additionally, it is known that once the skin of the neck of such patients is incised, often another free flap is necessary for tension-free cervical wound closure because of the radiogenic dermatofibrosis, altered extracellular matrix remodeling, and changes in vasculature and local host defense peptides, which significantly reduce the natural cervical cutaneous laxity and healing capacity ( 12 , 27 ).…”

“…However, in several severe ORN patients with extensive bone and soft tissue defects with or without intra-extraoral fistulation, functional and esthetic reconstruction represents a huge challenge for the patients and the whole team. An increased risk of postoperative wound-healing disorders—especially on the neck site due to altered immune competence—contributes to prolonged hospitalization duration and reduced quality of life ( 1 , 12 ).…”

“…Free flap reconstruction and mandibular reconstruction in previously operated and irradiated head and neck regions remain challenging and are more often associated with complications (1)(2)(3). Furthermore, osteoradionecrosis (ORN) of the jaws represents a common and severe complication after primary or adjuvant radiation therapy (RT) of large head and neck tumors.…”

In Vivo Bone Tissue Engineering Strategies: Advances and Prospects

“…Although vascularized bone flaps (e.g., fibula, scapula, or iliac crest) show a predictably high survival rate due to reliable blood supply, their harvesting can result in significant donor-site morbidity including chronic pain, lameness, hernia, ankle instability, etc. Moreover, such complications, as complete or partial flap failure, postoperative fistula, dehiscence, and bone exposure can occur [ 5 , 6 , 7 ]. Free flap harvest and revascularization substantially increase intraoperative blood loss volume, complexity, and duration of surgeries [ 8 ].…”

Minimally Invasive Two-Staged Surgery in the Treatment of Large Cystic Lesions of the Jaw

“…Primary excision of large mandibular cysts that have severely undermined the mandibular bone structure is not feasible due to the high risk of jaw fractures, challenging to treat considering the lack of bony tissue for stable plating [4]. The risk-benefit balance in patients with giant cystic lesions that do not exhibit other aggressiveness features does not favor extensive, complex reconstructive surgery in most cases, due to the increased incidence of perioperative complications [12,13]. Cystic decompression through marsupialization followed by second stage radical excision can be a valid therapeutic option in these patients, providing several advantages: cystic decompression with simultaneous biopsy for diagnostic confirmation, minimally invasive surgery conducted under local anesthesia, outpatient care or reduced hospitalization time, and rapid post-surgical recovery [14].…”