title: The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps.
abstract: Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74  ±  2.47. The mean postoperative PI value was 12.52  ±  2.34. The mean difference between the preoperative and postoperative PI values was -1.78 ± 0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P = 0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results.
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training And Research Hospital, Kartal, İstanbul, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Temiz
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Bilkay
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Yiğit Özer
authors.initials: YÖ
authors.lastname: Tiftikçioğlu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Darıca Farabi General Hospital Kocaeli, Turkey.
authors.forename: Candan Tevfik
authors.initials: CT
authors.lastname: Mezili
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Ecmel
authors.initials: E
authors.lastname: Songür
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005360:Fibula / Q000254:growth & development / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000502:physiology / Q000637:transplantation*; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies