title: Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction.
abstract: OBJECTIVE
  To evaluate perioperative complications in a homogeneous cohort undergoing microvascular osteocutaneous free flap (OCFF) reconstruction following segmental mandibulectomy for advanced oral cancer and to identify the causes of late OCFF failures.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The records of 65 adults who underwent a segmental mandibulectomy for primary oral cavity cancer followed by single-stage reconstruction OCFF were reviewed. Early and late complications were identified and their associations to patients' independent variables and to each other were analyzed to assess etiologic causes of late OCFF failure.
  
  
  RESULTS
  The incidence of early and late complications mirrored each another at 29%, and a 95% early-success rate was achieved. An early complication did predict an early infection (odds ratio [OR], 63.3; 95% confidence interval [CI], 6.8-585.3). Furthermore, an early perioperative infection impacted the incidence of late complications (OR, 4.8; 95% CI, 1.3-18.3), and moreover severely impacted the incidence of osteomyelitis/osteoradionecrosis (OR, 8.8; 95% CI, 1.8-41.9) and late failures (OR, 12.8; 95% CI, 1.9-84.5).
  
  
  CONCLUSIONS
  Mandibular reconstruction following segmental mandibulectomy provides immediate restoration but is often plagued with perioperative complications that are difficult to predict. Early perioperative infections impact patient long-term morbidity by increasing the risk of late graft failure by almost 13-fold. Consequently, it is felt that early aggressive treatment of these infections may reduce the incidence and severity of late complications and improve patient outcomes.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Hospital Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Zender
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.forename: Amy L
authors.initials: AL
authors.lastname: Pittman
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feustel
authors.forename: James J
authors.initials: JJ
authors.lastname: Jaber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D016038:Skin Transplantation; D017211:Treatment Failure