Early and late complications in the reconstructed mandible with free fibula flaps

• Published in: Journal of surgical oncology 2018-03, Vol.117 (4), p.773-780
• Main Authors: van Gemert, Johannes T.M., Abbink, Jan H., van Es, Robert J.J., Rosenberg, Antoine J.W.P., Koole, Ron, Van Cann, Ellen M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer surgery; Carcinoma, Squamous Cell - surgery; Chondrosarcoma - surgery; early complications; Female; Fibula - surgery; free fibula flap; Free Tissue Flaps; Head and Neck Neoplasms - surgery; Humans; late complications; major recipient site complications; Male; Mandible - surgery; Mandibular Neoplasms - surgery; mandibular reconstruction; Mandibular Reconstruction - adverse effects; Mandibular Reconstruction - methods; Middle Aged; Oral cancer; Osteosarcoma - surgery; Postoperative Complications - etiology; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24976

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.