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Early and late complications in the reconstructed mandible with free fibula flaps
Author(s) -
van Gemert Johannes T.M.,
Abbink Jan H.,
van Es Robert J.J.,
Rosenberg Antoine J.W.P.,
Koole Ron,
Van Cann Ellen M.
Publication year - 2018
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.24976
Subject(s) - medicine , fibula , surgery , relative risk , mandible (arthropod mouthpart) , free flap reconstruction , free flap , tibia , confidence interval , botany , biology , genus
Background and Objectives Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia. Methods Seventy‐nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N‐stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention. Results Sixty‐nine (87%) of the 79 fibula flaps were successful at the last follow‐up. Forty‐eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1‐20, P = 0.01). Twenty‐nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0‐8.3, P = 0.05). Conclusions Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications.