Outcomes in Pediatric Maxillofacial Reconstruction With Vascularized Fibular Flaps: A Systematic Review

Abstract

Background: The purpose of this study was to examine the complications and outcomes after maxillofacial reconstruction using the free fibular flap in the pediatric population. Methods: A systematic review and descriptive analysis were conducted using data variables, including study characteristics; patient characteristics; postoperative complications (major and minor); surgical revision; and dental rehabilitation. Results: The systematic review resulted in 1622 articles, 55 of which met inclusion criteria for this study. The 55 articles consisted of 17 case series and 38 case reports with level III/IV and level V of evidence, respectively. Of the 155 identified pediatric patients, the rate of major complications was 13.5% and minor complications was 24.5%. The most common complication was mild growth distortion (n = 7) at the recipient site. Complications at the donor site were less common. During follow-up, 29 patients (18.7%) underwent or awaited surgical revision, and 43 patients (27.7%) underwent or awaited dental rehabilitation. Conclusions: Our study suggests that the free fibular flap for pediatric maxillofacial reconstruction is safe and reliable. Additionally, surgical revision to correct the functional impairments resulting from primary reconstruction using the free fibular flap is relatively common.

Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta‐analysis

“…Within our study cohort of 439 patients, there were 131 recorded complication, translating to a 29.8% complication incidence. The most prevalent complications were early malocclusion and bite abnormalities; however, these numbers represent a lower complication rate relative to those reported by Cho et al (2022) in a comprehensive review of free flap procedures for pediatric maxillofacial reconstruction, which documented a complication rate of 38%. This discrepancy may be principally attributed to our methodological decision to independently categorize asymmetry and functional impairments due to the current lack of standardized metrics for these outcomes, while Cho et al (2022) chose to include asymmetry and functional impairments as a complication.…”

Pediatric Microsurgery and Free-Tissue Transfer

“…It has historically been thought that no growth will occur in the maxilla or mandible when growth centers (physis) are not included. 51,52 However, the senior author at our institution has documented several cases of postoperative growth in patients who did not receive physis transfer, likely due to inadvertent distraction from growth of the contralateral, normal mandible. 67,68 The vascularized fibula epiphyseal flap was first used in 1998 for proximal humeral reconstruction.…”

“…13 15 Vascularized fibula transfer has been successfully used for upper extremity (humerus, radius, ulna), lower extremity (femur, tibia), trunk (spine, pelvis), and craniofacial (maxilla, mandible) bony defects in children. 50 51 52 53…”

“…13,15 Vascularized fibula transfer has been successfully used for upper extremity (humerus, radius, ulna), lower extremity (femur, tibia), trunk (spine, pelvis), and craniofacial (maxilla, mandible) bony defects in children. [50][51][52][53] Anesthesia Since its application in surgical practice, general anesthesia has been a remarkable achievement in modern medicine, enabling immobilization and pain control during operations with seemingly safe implications. Nevertheless, recent evidence from studies involving nonhuman primates has established a link between commonly used anesthetic agents and brain neurotoxicity.…”

Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis

“…Autologous bone grafts, such as rib and tibia grafts or iliac crest and tibia grafts, can be combined with reconstruction plates for mandibular reconstruction [ 5 ]. Vascularized free flaps, particularly the free fibula flap (FFF), have gained popularity in recent years due to their potential for successful osseointegration and their ability to provide a robust and reliable source of bone for reconstruction [ 6 ]. Additionally, alloplastic materials, such as titanium plates and mesh, can be used to provide structural support and facilitate bone regeneration in cases where autologous grafts or flaps may not be suitable [ 7 ].…”