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Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap
Author(s) -
Chang Edward I.,
Yu Peirong
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24647
Subject(s) - medicine , osteoradionecrosis , fibula , surgery , free flap , hematoma , prospective cohort study , free flap reconstruction , radiation therapy , tibia
Background: A double island free fibula (DIFF) flap can be used for reconstruction of through‐and‐through or complex mandibulectomy defects, but prospective studies are lacking. Methods: Prospective analysis of all double skin paddle fibula flaps performed from 2010 to 2016. Results: Overall, 16 patients underwent reconstruction with a DIFF flap (average age: 59.1 years). One patient, who underwent a DIFF flap and developed osteoradionecrosis, requiring a second flap. Thirteen patients were males, and 7 had a history of smoking, 13 had prior radiation, and 14 had prior chemotherapy. The most common primary pathology was squamous cell carcinoma ( n  = 13). Reconstruction using the DIFF was predominantly for mandible reconstruction with one patient undergoing reconstruction following a orbitomaxillectomy. Complications included infection ( n  = 2), hematoma ( n  = 1), and donor site complications were limited. Two patients developed venous congestion requiring re‐exploration, and both flaps were successfully salvaged. One patient lost the external skin paddle requiring a pectoralis muscle flap, and there were no total flap losses. Conclusions: The DIFF flap is a reliable option that can reconstruct complex composite defects often obviating the need for a second free flap, thereby decreasing operating time, added donor site morbidity, and the need for additional recipient vessels.

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