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- Title
Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?
- Authors
McBee, Dylan B.; DiLeo, Michael J.; Keehn, Caroline C.; Huang, Andrew T.; Haskins, Angela D.; Hernandez, David J.
- Abstract
Purpose: This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. Methods: A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients' functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer's exact test, and 2-sample t tests were used to analyze differences among variables. Results: We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects (P <.001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P =.04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P >.99) and late (9% vs 8%, P >.99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P =.52) and recovery of a 100% oral diet (67% vs 54%, P =.53). Conclusion: Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.
- Subjects
MANDIBLE surgery; T-test (Statistics); SECONDARY analysis; FISHER exact test; TREATMENT effectiveness; RETROSPECTIVE studies; DESCRIPTIVE statistics; CHI-squared test; OSTEOTOMY; SURGICAL flaps; LONGITUDINAL method; SURGICAL complications; REOPERATION; MEDICAL records; ACQUISITION of data
- Publication
Annals of Otology, Rhinology & Laryngology, 2024, Vol 133, Issue 7, p672
- ISSN
0003-4894
- Publication type
Article
- DOI
10.1177/00034894241250177