Long‐Term Complications of Osteocutaneous Free Flaps in Head and Neck Reconstruction

Abstract

Objective To determine the frequency at which patients with osteocutaneous free flap reconstruction of the head and neck develop long-term complications and identify predisposing perioperative factors. Study Design A prospectively maintained database of free flaps performed at a single institution over a 10-year period was queried. Setting Single tertiary care referral center. Subjects and Methods In total, 250 osseous or osteocutaneous free flaps (OCFFs) for mandibular or maxillary reconstruction were analyzed. Data were collected on demographics, preoperative therapy, resection location, adjuvant treatment, complications, and subsequent surgeries, and multivariate analysis was performed. Subgroup analysis based on perioperative factors was performed. Results The median follow-up time was 23 months. In 185 patients with at least 6 months of follow-up, 17.3% had at least 1 long-term complication, most commonly wound breakdown, fistula or plate extrusion (13.5%), osteoradionecrosis or nonunion (6.5%), and infected hardware (5.9%). Prior chemoradiotherapy and cancer diagnosis predisposed patients to long-term complications. At the 5-year follow-up, 21.7% of patients had experienced a long-term complication. Conclusions Long-term complications after OCFF occurred in 17% of patients. In this series, a preoperative history of chemoradiation and those undergoing maxillary reconstruction were at high risk for the development of long-term complications and thus warrant diligent follow-up. However, OCFFs can often enjoy long-term viability and survival, even in the case of perioperative complications and salvage surgery.

Safety of fibula free flap in patients following total knee replacement

“…The main morbidity associated with FFF is difficulty with wound healing and paresthesias; however, some authors have reported gait disturbances and motor weakness 3,7 . Despite some limitations, there are relatively few long‐term complications given that the fibula is a non–weight‐bearing bone of the lower extremity 1,3,4 …”

“…Given the prevalence of knee replacement, it is not uncommon for the head and neck surgeon to encounter a patient with prior TKA during preoperative evaluation. In some instances, when a FFF is not possible due to prior trauma or peripheral vascular disease, most surgeons will turn to the osteocutaneous radial forearm (OCRFF) or scapular free flap 1,10 . A few have also harvested the anterolateral thigh osteocutaneous flap (ALTO) 11 .…”

“…Osteocutaneous free flaps have revolutionized functional and aesthetic reconstruction of the head and neck following trauma, osteonecrosis, and ablation of both benign and malignant tumors. [1][2][3] The fibula free flap (FFF), in particular, has emerged as a workhorse for large segment defects given its reliable pedicle, significant bone availability, and relatively limited morbidity. [4][5][6] The main morbidity associated with FFF is difficulty with wound healing and paresthesias; however, some authors have reported gait disturbances and motor weakness.…”

“…3,7 Despite some limitations, there are relatively few longterm complications given that the fibula is a non-weightbearing bone of the lower extremity. 1,3,4 Total knee arthroplasty (TKA) is one of the most common procedures performed in the United States, with approximately 600 000 cases performed each year. 8 During TKA, the damaged cartilaginous surfaces at the ends of the femur and tibia are removed, along with some aspects of bone, and metal implants and a plastic spacer are cemented into the bone.…”

“…In some instances, when a FFF is not possible due to prior trauma or peripheral vascular disease, most surgeons will turn to the osteocutaneous radial forearm (OCRFF) or scapular free flap. 1,10 A few have also harvested the anterolateral thigh osteocutaneous flap (ALTO). 11 Despite these alternative options, for large segment defects, it is difficult to replace the amount of bone afforded by the FFF.…”