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. 2021 May;25(5):2905-2914.
doi: 10.1007/s00784-020-03607-8. Epub 2020 Oct 6.

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Lucas M Ritschl  1 , Thomas Mücke  2 , Diandra Hart  3 , Tobias Unterhuber  3 , Victoria Kehl  4 , Klaus-Dietrich Wolff  3 , Andreas M Fichter  3
Affiliations

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Lucas M Ritschl et al. Clin Oral Investig. 2021 May.

Abstract

Objectives: The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors.

Materials and methods: Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed.

Results: One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications.

Conclusions: Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique.

Clinical relevance: A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

Keywords: Complications; Free bone flaps; Free fibula flap; Mandibular reconstruction; Radiation.

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Conflict of interest statement

Author LMR declares that he has no conflict of interest. Author TM declares that he has no conflict of interest. Author DH declares that he has no conflict of interest. Author TU declares that he has no conflict of interest. Author VK declares that he has no conflict of interest. Author KDW declares that he has no conflict of interest. Author AMF declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
Sunburst diagram with the distribution of reconstruction techniques according to the underlying indication for mandibular reconstruction (FFF, free fibula flap; DCIA, deep circumflex iliac artery; CAD/CAM, computer-aided design and computer-aided manufacturing; ORN, osteoradionecrosis; MRONJ, medication-related necrosis of the jaw)
Fig. 2
Fig. 2
Treatment algorithm for mandibular reconstructions on the basis of our results. Brown’s classification was used to describe the mandibular defect situation [55]
See this image and copyright information in PMC

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