Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting. Issue 3 (September 2019)

• Record Type: Journal Article
• Authors: Verhelst, Pieter-Jan; Dons, Flore; Van Bever, Pieter-Jan; Schoenaers, Joseph; Nanhekhan, Lloyd; Politis, Constantinus
• Is Part Of: Craniomaxillofacial trauma & reconstruction. Volume 12:Issue 3(2019)
• Page Start: 183
• Page End: 192
• Publication Date: 2019-09
• Subjects: fibula free flap -- reconstruction -- risk factor -- flap failure -- complication; Face -- Wounds and injuries -- Periodicals; Face -- Surgery -- Periodicals; Maxilla -- Wounds and injuries -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery; Face -- Wounds and injuries; Maxilla -- Surgery; Maxilla -- Wounds and injuries; Maxillofacial Injuries -- Periodicals; Craniocerebral Trauma -- Periodicals; Reconstructive Surgical Procedures -- methods -- Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 617.522
• DOI: 10.1055/s-0038-1651515
• Languages: English
• ISSNs: 1943-3875

Abstract

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.