Indications and Outcomes for Mandibular Reconstruction Using Sequential Bilateral Fibula Flaps

• Published in: Plastic and reconstructive surgery (1963) Vol. 126; no. 5; pp. 1539 - 1547
• Main Authors: Matros, Evan, Schwarz, Graham S., Mehrara, Babak J., Hu, Qunying Y., Cordeiro, Peter G., Disa, Joseph J.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Society of Plastic Surgeons 01-11-2010; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Biological and medical sciences; Bone Transplantation; Female; Fibula; Humans; Male; Mandible - surgery; Medical sciences; Middle Aged; Mouth Neoplasms - surgery; Neoplasm Recurrence, Local; Neoplasms, Second Primary - surgery; Reconstructive Surgical Procedures; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Treatment Outcome; Mandible; Fibula; Prognosis; Treatment; Indication; Surgery; Bilateral; Anatomical reconstruction; Flap (surgery)
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0b013e3181ef8c86

A subset of patients with recurrent or second intraoral tumors undergo both primary and secondary mandibular reconstruction using bilateral fibula flaps. The objective of this report is to describe indications and outcomes for these patients.
A retrospective analysis of a prospectively collected database was performed. Charts were reviewed to identify demographics, operative features, and functional outcomes.
Ten patients underwent mandibular reconstruction with a second fibula flap for recurrent or second oral tumors. Time between flaps averaged 20 months. Bone gap size measured 8 cm after both resections. Eighty percent of secondary resections included the mandibular arch, in contrast to 20 percent of primary resections (p=0.070). Compared with primary resections, secondary soft-tissue defects were larger and more frequently included composite tissues. There were low complication rates and no flap failures after both reconstructions. Functional evaluation showed a greater dependency on supplemental enteral nutrition after the second resection (p=0.033). Five patients died at a median of 12.5 months after the second resection and the remaining patients have survived for a median of 18.6 months.
The principal indication for second fibula flaps in mandibular reconstruction is central segment defects where rigid support is required to prevent sequelae of the Andy Gump deformity. For lateral resections, the large soft-tissue deficits of secondary extirpation may be better served by reconstruction with soft-tissue flaps. Second osseous free flaps can be performed safely, but with a significant decline in postoperative oropharyngeal function. Goals of surgery and quality of life need to be addressed before ablation of recurrent or second oral tumors is performed.