Jaw reconstruction with vascularized fibular flap: The 11-year experience among 104 patients

Abstract

Background: A vascularized fibular osteomyocutaneous flap with severe vascular crisis often results in serious consequences. This study aims to examine the clinical effect of non-vascularized fibular graft on patients with severe vascular crisis after reconstruction of the defect jaw with vascularized fibular osteomyocutaneous flap. Materials and methods: From December 2007 to December 2018, a total of 104 patients with jaw neoplasms that underwent reconstruction with free vascularized fibular flap were retrospectively analyzed; seven of these cases had postoperative vascular crisis during mandibular reconstruction. Results: Of the seven cases with postoperative vascular crisis, the vascularized fibular flaps in three patients survived completely, thanks to early detection; two cases were completely necrotic and removed in the end, and the remaining two cases had severe vascular crisis after the removal of the soft tissue attached to the fibular flap. The non-vascular fibular grafts were retained regardless of the severe absorption after follow-ups for 25 and 69 months, respectively. Conclusions: If vascular crisis occurs following jaw reconstruction with a vascularized fibular osteomyocutaneous flap, early re-surgical exploration effectively improves the salvage rate. In addition, when a severe vascular crisis occurs, the vascularized fibular flap can be changed to a non-vascular fibular graft to reconstruct the mandibular defect, thus avoiding the serious consequences resulting from the complete failure of fibular graft.

<p>Mandibulektomi segmental dengan rekonstruksi cangkok tulang fibula non-vaskularisasi pada pasien ameloblastoma tipe folikuler</p><p>Segmental mandibulectomy with non-vascularised fibular bone graft reconstruction in follicular ameloblastoma patient</p>

“…13,14,15 Kekurangan dari cangkok tulang nonvaskularisasi adalah kenyataan bahwa cangkok ini hanyalah cangkok avaskuler, yang dapat meningkatkan kemungkinan infeksi dan kegagalan cangkok jika panjang defek lebih panjang. 20,21,22,23 Studi yang dilakukan Pogrel dkk telah melaporkan kasus kegagalan 17% untuk cacat 6 cm dan 75% untuk cacat 12 cm atau lebih untuk cangkok nonvaskularisasi. Mereka merekomendasikan cangkok tulang vaskularisasi untuk rekonstruksi cacat mandibula dengan panjang lebih dari 9 cm.…”

“…Fiksasi yang kuat adalah suatu keharusan untuk mencapai penyatuan dan locking plate lebih disukai daripada pelat non-locking plate konvensional karena memiliki sekrup pengunci bikortikal sehingga perpindahan dari permukaan tulang minimal dan memberikan konstruksi yang lebih stabil. 21,22,23,27,29,30 Ahli bedah pada kasus ini, menggunakan pelat titanium 6 lubang dengan span di masing-masing sisi menggunakan 6 sekrup bikortikal di setiap sisi cangkok tulang untuk memasang rahang bawah dengan cangkok tulang fibula.…”

Free Fibula Flap in Head and Neck Reconstruction: Our Experience of 300 Cases

“…Notably, vascular anastomosis is required in a free tissue flap; therefore, it is of great importance to detect vascular crisis in the anastomotic blood vessels at the early stage, and to carry out surgical exploration and treatment immediately for achieving successful operation. The delayed discovery of vascular crisis or the presence of the more serious vascular crisis may result in complete necrosis of the free transplanted tissue flap, thereby inducing severe consequences [7].…”

Current global research on mandibular defect: A bibliometric analysis from 2001 to 2021

“…There are various insolvable problems, such as free bone graft infection, bone resorption, and flap transplantation. It may cause donor site dysfunction; artificial materials have no bone-binding ability, and the distraction osteogenesis treatment cycle is long ( Hopper et al, 2020 ; Shao et al, 2020 ; Li et al, 2022 ; Shin et al, 2022 ; Wu et al, 2022 ). Therefore, there is no ideal method for treating mandibular defects.…”