Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-10-16 DOI:10.1002/micr.31243
Ayham Al Afif, Alex Peña-Garcia, Carissa M. Thomas, Joshua J. Kain, Jessica W. Grayson, Kiranya E. Tipirneni, Lindsay S. Moore, Hari Jeyarajan, Larissa Sweeny, Lisa Clemons, Eben L. Rosenthal, Benjamin J. Greene
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Abstract

Background

This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN).

Methods

Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis.

Results

Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, p = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% p = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, p = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201–2.706, p = 0.688).

Conclusion

The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.

比较前臂桡骨皮瓣和腓骨游离皮瓣在下颌骨骨坏死重建中的效果
背景 本研究比较了骨皮桡前臂游离皮瓣(OC-RFFF)和腓骨游离皮瓣(FFF)重建下颌骨骨坏死(ORN)的疗效。 方法 回顾性分析 2005 年至 2020 年间在一家三级医院接受 OC-RFFF/FFF 重建术治疗下颌骨骨坏死的患者。采用卡方和逻辑回归分析评估患者特征、术后并发症和功能预后。 结果 共纳入 56 例患者(OC-RFFF:38 例;FFF:18 例)。下颌骨外侧缺损的 OC-RFFF 患者明显更多(94% 对 61%,P = 0.0014)。在 OC-RFFF 组中,口内骨质暴露的患者明显更多(23% 对 0% p = 0.02),但在硬件并发症或皮瓣失败方面没有明显差异。FFF组的供体部位部分植皮损失更常见(22% 对 2.6%,P = 0.016),但供体部位发病率无其他显著差异。双变量分析显示,皮瓣类型、吸烟/饮酒、糖尿病或甲状腺功能减退对术后并发症没有影响。60% 的 OC-RFFF 患者和 67% 的 FFF 患者在术后恢复了口服饮食。口服饮食不受皮瓣类型的影响(OR = 0.769,95% CI = 0.201-2.706,P = 0.688)。 结论 OC-RFFF 是重建下颌骨外侧 ORN 的一种可接受的选择,但会增加骨暴露的风险。这些发现有助于指导外科医生选择微血管游离皮瓣供体部位,并为患者提供适当的咨询。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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