Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula f
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ORIGINAL ARTICLE
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 1 & Tobias Unterhuber 1 & Victoria Kehl 3 & Klaus-Dietrich Wolff 1 & Andreas M. Fichter 1 Received: 19 May 2020 / Accepted: 25 September 2020 # The Author(s) 2020
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 Mandibular reconstruction . Free bone flaps . Free fibula flap . Complications . Radiation
Introduction Mandibular reconstruction after partial or continuity resection is a complex procedure with non-negligible sequela on the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00784-020-03607-8) contains supplementary material, which is available to authorized users. * Lucas M. Ritschl [email protected] 1
Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany
2
Department of Oral and Maxillofacial Surgery, Malteser Kliniken Rhein-Ruhr, Kurfürstenstraße 69, 47829 Krefeld-Uerdingen, Germany
3
School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Grillparzerstraße 18, 81675 Munich, Germany
oro-pharyngeal integrity and function, aesthetics and quality of life [1–3]. With continuous technical and surgical improvements, the restoration of mandibular continuity has become a highly standardized procedure in high-volume centres over the last decades. Microvascular tissue transplantation has evolved to a gold standard procedure in reconstructive cranio-maxillofacial surgery, especially since the introduction of the free fibula flap (FFF) for mandibular reconstruction by Hidalgo [4, 5]. An
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