Free Flap Reconstruction of Lateral Mandibular Defects: Indications and Outcomes

Abstract

Objective-To compare outcomes following osteocutaneous radial forearm and fibula free flap reconstruction of lateral mandibular defects.Study Design-Retrospective case controlled study. Setting-Two academic tertiary care centers.Subjects and Methods-Patients who underwent free flap reconstruction of lateral mandibular defects from 1999 to 2010 were classified into four groups based on type of reconstruction: 1) radial forearm swing (n = 8), 2) radial forearm with bar (n = 5), 3) osteocutaneous radial forearm (n = 73) and 4) fibula free flap reconstruction (n = 51). Patient characteristics, length of hospital stay, recipient and donor site complications, and long term outcomes including postoperative diet were evaluated.Results-The majority of patients were male (67%) and presented with advanced T-stage (73%) squamous cell carcinoma (93%) involving the alveolus (26%) retromolar trigone (21%) or oral tongue (25%). Median length of hospital stay was 8 days (range 4-22). The recipient site complication rate approached 34% and included infection (n=11), mandibular malunion (n=9), exposed bone or mandibular plates (n=11) and flap failure (n=5). Most patients demonstrated little to no trismus following reconstruction (81%) and were able to resume a regular or edentulous diet (61%). No difference in complication rates or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P > 0.05). One patient underwent dental implantation following osteocutaneous radial forearm free flap reconstruction. No patients from the fibula free flap group underwent dental implantation. Conclusion-The osteocutaneous radial forearm and fibula free flap provide equivalent wound healing and functional outcomes in patients undergoing lateral mandibular defect reconstruction.

Surgical outcomes in the elderly patient after osteocutaneous free flap transfer

“…24 Some authors report donor site complications in the radial osteocutaneous flap at a rate of 0% to 7%, none of which are fractures. 21,23,25 These rates increase in other studies to 28% to 30% when tendon exposure is included. 23,26 In these studies, the need for surgical revision of the donor site is still low at 0% to 7%.…”

Predictors of plate extrusion in oromandibular free flap reconstruction

“…Deficiencies in soft tissue coverage may be an important factor in the development of plate extrusion. Several authors have noted that hardware exposure occurred at a higher rate in patients who underwent osseocutaneous radial forearm free flaps (OCRFFF) versus fibular free flaps (FFF), and concluded that this was likely due to the smaller amount of soft tissue incorporated in the OCRFFF (Day et al, ; Dean et al, ; Virgin et al, ). The subscapular system of free flaps makes available considerable soft tissue bulk with excellent mobility of the soft tissue relative to the bony component and generally provides abundant soft tissue coverage of the reconstruction plate (Gibber et al, ; Urken et al, ; Yoo et al, ).…”

The use of the Radial Styloid in the Extended Osteocutaneous Radial Forearm Free Flap

“…The results show that these flaps are similar with respect to complications and provide equivalent functional outcomes (7,8). Interestingly, despite evidence suggesting the OC-RFFF cannot support dental implants (18), both studies reported more patients in the OC-RFFF group receiving implants than in the fibula group (7,8). Dental implants typically require the addition of supplemental bone graft in the case of the OC-RFFF or fubula.…”

“…The rate of fracture when all patients undergo PIF was 0.5% in two large retrospective reviews (3,9), and 0% (25,26) to 9.6% in smaller similar series (5,27). Routine PIF appears to have reduced the fracture risk associated with the OC-RFFF, even in the setting of large bone flaps (harvest of 40% to 50% of the radius circumference) (3,7,25). Because this is a new modification, there are no data regarding the effect of including the border of the radial styloid on fracture risk, although we suspect it will not affect the fracture rate because invariably, the fracture occurs proximally where the radius is the narrowest.…”