Does ischemia time affect the outcome of free fibula flaps for head and neck reconstruction? A review of 116 cases.
BACKGROUND
The fibula osteoseptocutaneous flap is an excellent option for the reconstruction of segmental mandibular defects. This study was conducted to investigate the relationship between ischemia time and outcome of the fibula flap, thus establishing the critical ischemia time for this procedure.


METHODS
Between February of 2003 and March of 2005, 114 patients who underwent 116 fibular osteoseptocutaneous flaps for head and neck reconstruction were reviewed retrospectively. Complications were classified as acute, subacute, or chronic based on the time at which they were detected postoperatively. Outcomes among different ischemia time groups were evaluated: group A, less than 3 hours; group B, 3 to 4 hours; group C, 4 to 5 hours; and group D, 5 to 7 hours.


RESULTS
The mean success rate of the fibula osteoseptocutaneous flap was 98.3 percent. Mean flap ischemia time was 3.6±0.97 hours. Sixty-six patients (56.9 percent) experienced one or more complications at different stages (86 complications total). There were no statistically significant differences in acute, subacute, and chronic complications among the four groups (p=0.6, p=0.6, and p=0.2, chi-square test). The overall complication rate was significantly higher in group D (81.8 percent) (p=0.03, chi-square test). The partial flap loss rate was also statistically higher in group D (45.5 percent) compared with the other three groups (12.1, 12.2, and 8.7 percent) (p=0.02, chi-square test).


CONCLUSIONS
: Using the fibula osteoseptocutaneous flap for head and neck reconstruction, ischemia times less than 5 hours do not increase complication rates in different postoperative stages. However, the critical ischemia time of the fibula osteoseptocutaneous flap should be limited to 5 hours to reduce partial skin paddle loss and overall complications.
Taoyuan, Taiwan From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine.
Shu-Ying
SY
Chang
Jung-Ju
JJ
Huang
Chung-Kan
CK
Tsao
Anh
A
Nguyen
Krithi
K
Mittakanti
Chia-Yu
CY
Lin
Ming-Huei
MH
Cheng
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D002277:Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002648:Child; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000601:surgery*; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D052096:Warm Ischemia; D055815:Young Adult