Fibula osteomyocutaneous free flap in mandibular reconstruction: clinical experience in a community-based hospital

Abstract

Background

The fibula free flap (FFF) constitutes the gold standard surgical approach for mandibular reconstruction. Mandible reconstruction is routinely performed in high-volume academic centers. To our best knowledge, this is the first case series exclusively dedicated on FFF conducted in community hospitals. This study evaluates our 10-year experience with FFF mandible reconstruction in two community hospitals.

Methods

This is a retrospective review of all 12 patients who underwent partial or total mandibulectomy with concomitant mandible reconstruction using FFF from September 2005 through February 2015.

Results

The majority of the patients were men (75%) with a mean age of 61 years. Eleven (91.7%) patients had malignancies of the head and neck, and 10 (83.3%) received preoperative XRT. Overall flap survival was 100%, with no arterial/venous thrombosis or malunion. Partial flap failure (with skin paddle necrosis) was reported in only 1 patient, but the bone was viable and survived. Recipient-site wound infection, hardware exposure, and orocutaneous fistula occurred among previously irradiated patients, and in those who were suffering from osteoradionecrosis.

Conclusions

Our FFF outcomes were non-inferior to those reported in specialized university hospitals and are evidence that successful results can be obtained outside of high-volume academic centers. FFF represents a reliable surgical approach for mandible reconstruction in university and community hospitals.

Level of Evidence: Level IV, therapeutic study.