Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap

Abstract

Background: The osteocutaneous radial forearm free flap (OC-RFFF) has been proposed as a safe and reliable free flap for head and neck reconstruction with low donor site morbidity. The purpose of this study is to compare the late complications (>30 days) associated with using the OC-RFFF versus the free fibula flap (FFF) for mandibular reconstruction following oncologic segmental resection. Methods:We conducted a single-institution, retrospective study composed of patients who underwent oncologic microvascular composite mandibular reconstruction with either the OC-RFFF or FFF. The primary predictor variable was the type of free flap used. The outcome variable was late complication postoperatively (>30 days).Results: A total of 93 patients (28, OC-RFFF and 65, FFF) were analyzed. The majority of patients were male (62%) and with AJCC stage T4a disease (72%). Mean hospital length of stay was comparable between the two flap groups (p = .50). OC-RFFF was associated with more late complications (p = .03) compared to FFF. Nonunion occurred in 10.7% of OC-RFFF and 0% of FFF. Partial or complete flap failure was seen in 7.1% and 0% in the OC-RFFF and FFF, respectively. Two-year disease-free survival was comparable in both groups (p > .05). Conclusions:The results of this study suggest that the rate of nonunion and odds of having a late complication were significantly greater in the OC-RFFF compared to the FFF following oncologic mandibular reconstruction. However, flap success, early complications (<30 days), and length of hospital stay were comparable between the two flaps. | INTRODUCTIONComposite mandibular defects resulting from oral cancer may be reconstructed using a number of free vascularized bone flaps harvested from the fibula, scapula, ilium, or radius (Bak et al., 2010;Disa & Cordeiro, 2000). Additionally, although less commonly used, the medial femoral condyle, rib, humerus, and tibia have also been described as osseous donor sites associated with low failure rates and minimal donor site morbidity (Banaszewski et al., 2019;Brown et al., 2017;Mulholland et al., 2013). To date, there remains no randomized controlled trial or consensus on flap selection for composite mandibular defects. Instead, flap selection is made mostly on the surgeon's preference, training, experience, guided by existing outcomesbased research (Takushima et al., 2005). For many reconstructive

Perioperative Outcomes in Patients Who Underwent Fibula, Osteocutaneous Radial Forearm, and Scapula Free Flaps

“…Several series have compared rates of complications between OCRFFFs and FFFs, and generally no differ-ence has been seen; however, complication rates may have been somewhat affected by studies that were inadequately powered to detect differences on the magnitude of 5% to 10%. [9][10][11]14 In the most recent comparative study from 2021, Le et al 14 compared complication rates for 65 FFFs and 28 OCRFFFs. Acute salivary leaks occurred in 8 FFFs (12%) vs 1 OCRFFF (4%).…”

“…Perioperative outcomes and complications associated with osseous head and neck reconstruction are relatively well described in the literature but are generally limited to single-institution reviews devoted to a single donor site or a comparison between 2 flap types. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The series that have included data on all 3 osseous flap types have generally been underpowered to evaluate potential differences in outcomes among these 3 donor sites. 3,4,10,11 Further delineating the association between osseous free flap type and perioperative outcomes could be valuable to head and neck reconstructive surgeons and their patients.…”

Outcome Assessment after Reconstruction of Tumor-Related Mandibular Defects Using Free Vascularized Fibular Flap—A Clinical Study

“…It included the placement of reconstruction plates joining the defect segments, which were augmented with non-vascularized bone grafts, but they would often be placed without any bone graft. The thin and mobile oral mucosa pulled down against the narrow edge of the plate due to the weight of the remaining underlying muscles or the bulky pedicle flaps used for soft tissue reconstruction, which usually caused plate exposure, especially after radiotherapy, in such patients [5,6].…”

Meet the Founding Resident Ambassador: John M. Le, DDS, MD

“…John M. Le, DDS, MD (Fig 1) and his colleagues in the Department of Oral and Maxillofacial Surgery at the University of Alabama at Birmingham have made a serious impact on global OMS specialty. [4][5][6][7][8][9][10][11][12][13][14][15] Moreover, their article contribution to our journal in 2020 made a huge influence by attracting an international community of readers to our journal, making us enormously proud. The masterpiece was dedicated to the use of zygomatic implants for restoration of complex nasal defects.…”