From “equal” to “unequal” combination of anterolateral thigh flap and fibula flap for extensive composite oromandibular defects

Chang, Tsuey Yu; Lee, Jing Syuan; Lee, Yao-Chou

doi:10.1002/micr.30223

Cited by 3 publications

(7 citation statements)

References 3 publications

(2 reference statements)

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“…Although the decision of single or double flaps for reconstruction should consequently aim for better outcomes and quality of life, both bony defect (<13 cm) and the large soft tissue volume requirement (<135 cm 2 ) were the remarkable considerations of a chimeric flap, unless there is contraindication of flap harvesting 22,24 . The presented algorithm was partially consistent with our results 21 . Apart from the surgeon's experience, the total surface area >159 cm 2 in through-and-through COMDs revealed a higher risk of thromboembolic event and finally caused prolonged ICU stay in our analysis.…”

Section: Discussionsupporting

confidence: 85%

“…22,24 The presented algorithm was partially consistent with our results. 21 Apart from the surgeon's experience, the total surface area >159 cm 2 in through-and-through COMDs revealed a higher risk of thromboembolic event and finally caused prolonged ICU stay in our analysis.…”

Section: Discussionmentioning

confidence: 70%

“…Therefore, the cutoff level may not be suitable for Asians. To lower the postoperative complications, the method of unequal combination of 2 flaps was thus described 21 …”

Section: Discussionmentioning

confidence: 99%

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Total Surface Area of a Through-and-Through Oromandibular Defect Is Associated With Thromboembolic Events for Reconstruction With a Single Fibula Free Flap

Chen

Wang

et al. 2023

Ann Plast Surg

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Background: Reconstruction of through-and-through composite oromandibular defects (COMDs) has been a challenge to plastic surgeons for decades. When using a free osteoseptocutaneous fibular flap, the skin paddle is restricted by the orientation of the peroneal vessels and the inset of bone segment(s). Although the combination of double flaps for extensive COMDs is viable and reliable, the decision of single-or double-flap reconstruction is still debated, and the risk factors leading to complications and flap failure of single-flap reconstruction are less discussed. Aim and Objectives: The aim of this study was to determine objectively predictive factors for postoperative vascular complications in through-and-through COMDs reconstructed with a single fibula flap. Methods: This was a retrospective cohort study in patients who underwent single free fibular flap reconstruction for through-and-through COMDs in a tertiary medical center from 2011 to 2020. The enrolled patients' characteristics, surgical methods, thromboembolic event, flap outcomes, intensive care unit care, and total hospital length of stay were analyzed. Results: A total of 43 consecutive patients were included in this study. Patients were categorized into a group without thromboembolic events (n = 35) and a group with thromboembolic events (n = 8). The 8 subjects with thromboembolic events were failed to be salvaged. There was no significant difference in age, body mass index, smoking, hypertension, diabetes mellitus, and history of radiotherapy. The length of bony defect (6.70 ± 1.95 vs 9.04 ± 2.96, P = 0.004) and the total surface area (105.99 ± 60.33 vs 169.38 ± 41.21, P = 0.004) were the 2 factors that showed a significant difference between the groups. Total surface area was the only significant factor in univariate logistic regression for thromboembolic event ( P = 0.020; odds ratio, 1.02; 95% confidence interval [CI], 1.003-1.033) and also in multivariate logistic regression analysis after adjusting confounding factors ( P = 0.033; odds ratio, 1.026; 95% CI, 1.002-1.051).The cutoff level of total surface area in determining thromboembolic event development was 159 cm 2 ( P = 0.005; sensitivity of 75% and specificity of 82.9%; 95% CI, 0.684-0.952). Conclusions: Free fibula flap has its advantages and drawbacks on mandible restoration. Because there is a lack of indicators before, a large total surface area may be an objective reference for single-flap reconstruction of through-and-through COMDs due to an elevated risk of thromboembolic event.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 70%

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Total Surface Area of a Through-and-Through Oromandibular Defect Is Associated With Thromboembolic Events for Reconstruction With a Single Fibula Free Flap

Chen

Wang

et al. 2023

Ann Plast Surg

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“…The evolution of this strategy started with simplification of the flap-tissue arrangement, by placing the fibula skin flap as an optional monitoring flap and using the anterolateral thigh skin flap for the essential inner lining and outer coverage. 5 This simplification has the added benefit of removing the need to wait for an evaluation of the mucosal defect before starting the fibula flap harvest, allowing both flaps to be harvested earlier to prepare them before completion of mandibulectomy. Later, we noticed that the defect-site reconstruction was delayed because of the fibula bone shaping process.…”

Section: Methodsmentioning

confidence: 99%

“…3 ). 5 With this approach, both flaps can be harvested before the mucosal defect is defined, and the process of finalizing the flap inset is also simplified.…”

Section: Methodsmentioning

confidence: 99%

Simplifying the Combined Use of Fibula Flap and Anterolateral Thigh Flap for Oromandibular Reconstruction

Tsai¹,

Lee²

2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Although the preferred technique for reconstruction of extensive composite oromandibular defects involves the use of a fibula flap for the inner mucosal lining and mandibular bone reconstruction and an anterolateral thigh flap for outer skin coverage and soft tissue replenishment, this approach is complicated and manpower-dependent. It also often involves prolonged operations requiring nighttime surgery with insufficient manpower in an era of restricted working hours for residents, which can negatively affect the surgical outcomes. Traditionally, the mucosal defect is first defined and the fibula flap is then dissected to ensure a size-matching skin flap for the inner lining. This flap is transferred first after mandibulectomy is completed, but is delayed by the fibula bone shaping process. Finalizing the flap inset is a sophisticated process involving the fibula bone, fibula skin, and anterolateral thigh skin. Thus, we developed a strategy to overcome the late start of fibula flap harvest, the delayed initiation of defect-site reconstruction, and the troublesome flap inset. Briefly, we dissected both flaps sequentially or simultaneously from contralateral limbs before the mucosal defect was defined, so that the flaps were ready in the daytime. Once the mandibulectomy was completed, we transferred the anterolateral thigh flap first while the fibula bone was shaped, and simplified the flap inset by using the anterolateral thigh skin for the inner lining and outer coverage and the fibula skin as a monitoring flap. We employed this approach in five patients and completed postmandibulectomy reconstruction in as fast as 4 hours.

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One-stage reconstruction of extensive composite extremity defects with low donor site morbidity: A retrospective case series of combined transfer of a vascularized fibula flap and a perforator flap

Qing

et al. 2022

Injury

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From “equal” to “unequal” combination of anterolateral thigh flap and fibula flap for extensive composite oromandibular defects

Cited by 3 publications

References 3 publications

Total Surface Area of a Through-and-Through Oromandibular Defect Is Associated With Thromboembolic Events for Reconstruction With a Single Fibula Free Flap

Total Surface Area of a Through-and-Through Oromandibular Defect Is Associated With Thromboembolic Events for Reconstruction With a Single Fibula Free Flap

Simplifying the Combined Use of Fibula Flap and Anterolateral Thigh Flap for Oromandibular Reconstruction

One-stage reconstruction of extensive composite extremity defects with low donor site morbidity: A retrospective case series of combined transfer of a vascularized fibula flap and a perforator flap

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