Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case\u2013control study

Sho Yamakawa,Kenji Hayashida

doi:10.1186/s12893-021-01194-3

Abstract

BackgroundFree osteocutaneous fibula flap (FFF) is currently considered the best option for segmental mandibular reconstruction; however, there are only a few reports comparing secondary with primary reconstructions using FFF. This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using FFF when compared with primary mandibular reconstruction.MethodsFrom October 2018 to February 2020, patients who underwent mandibular reconstruction using FFF after segmental mandibulectomy were retrospectively reviewed. The size and location of the mandibular defect, the segment length and number of osteotomies in the fibula, types of the mandibular plating system, kinds and laterality of the recipient vessels were recorded from the surgical notes. Flap survival, duration of nasogastric tube use, and implant installation after reconstruction were recorded as postoperative evaluation indices.ResultsTwelve patients underwent mandibular reconstruction using FFF during the study period. There were no significant differences in demographic characteristics other than body mass index between the primary (n = 8) and secondary (n = 4) reconstruction groups. No significant differences were observed in the size and location of defects, the segment length and number of osteotomies in the fibula, and the types of mandibular plating system. There was no significant difference in the kinds of recipient vessels; however, the laterality of recipient vessels was ipsilateral in all cases of primary reconstructions and contralateral in all cases of secondary reconstructions. Three out of eight patients with primary FFF reconstruction developed partial flap necrosis. Four patients in the secondary FFF reconstruction group achieved complete flap survival. The duration of use of the nasogastric tube and implant installation after reconstruction was comparable between the two groups.ConclusionSafe and effective secondary mandibular reconstruction can be performed in this clinical case study using FFF.

Highlights

Among the various flaps, free osteocutaneous fibula flap (FFF) is currently considered the best option for primary mandibular reconstruction in terms of durability and its ability to withstand long-term use [1]
This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using Free osteocutaneous fibula flap (FFF) when compared with primary mandibular reconstruction
The recipient vessels were recorded in respective cases, and the laterality of the recipient vessels used in the secondary mandibular reconstruction was defined in relation to the primary defect

Summary

Introduction

Free osteocutaneous fibula flap (FFF) is currently considered the best option for primary mandibular reconstruction in terms of durability and its ability to withstand long-term use [1]. Access to microsurgical procedures for reconstructive surgery is difficult due to various limitations such as the shortage of skilled plastic surgeons, insufficient surgical instruments, and lack of educational activities for patients, especially in rural areas [2]. In such situations, mandibular bridging with nonvascular bone grafting or a reconstruction plate must be selected for mandibular continuity. Free osteocutaneous fibula flap (FFF) is currently considered the best option for segmental mandibular reconstruction; there are only a few reports comparing secondary with primary reconstructions using FFF. This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using FFF when com‐ pared with primary mandibular reconstruction

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Discussion

Conclusion