Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases.
OBJECTIVE
The objective of this study was to analyze complications following fibular free flap (FFF) transfer for mandibular reconstruction using our definition of postoperative complications.


METHODS
Retrospective observational study.


METHODS
This retrospective study presents our 4-year experiences with FFF for mandibular reconstruction by a single microsurgical team. Data were collected through patient record review and clinical evaluation by 2 independent assessors. We defined complications as any unwanted postoperative outcomes that compromised patient care. Early complication occurred within the first 2 weeks postoperatively; late complications occurred afterward.


RESULTS
Of 25 patients included, 13 patients (56%) experienced complications. Early and late complications occurred in 13 and 9 patients, respectively. These included flap loss, malunion, skin-paddle necrosis, orocutaneous fistula, wound dehiscence, hematoma, soft tissue contracture, intraoral hair growth, facial asymmetry, osteoradionecrosis, donor-site morbidity, and medical complications. Revision surgeries were performed in 10 patients, ranging from wound dressing to flap removal. All but 2 flaps survived, yielding an overall success rate of 92%. Most of the patients were alive without disease (92%) at the end of the study. Average follow-up was 47.2 months (range: 26-77).


CONCLUSIONS
Despite the small number of patients, these preliminary data suggest a relatively high frequency of complications following the FFF reconstruction based on our definition. Minor complications are common and should not be neglected because they may lead to devastating consequences. This should also be a part of informed consent for patients. Complications after the FFF transfer await keen evaluation to establish guidelines to improve end results.
Chaine
André
A
Department of Maxillofacial Surgery, AP-HP, Pitié-Salpêtrière University Hospital, Faculty of Medicine, University Paris 6 (Pierre et Marie Curie), Paris, France.
Pitak-Arnnop
Poramate
P
Hivelin
Michael
M
Dhanuthai
Kittipong
K
Bertrand
Jacques-Charles
JC
Bertolus
Chloé
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D003286:Contracture / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology; D005146:Facial Asymmetry / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006197:Hair / Q000473:pathology; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis; D016155:Oral Fistula / Q000209:etiology; D010025:Osteoradionecrosis / Q000209:etiology; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult