The Fibula Free Flap as Used for Reconstruction in Patients With Oral Cavity Malignancy: A Systematic Review.

Abstract

Objectives: The fibula free flap is a widely used means of reconstructing the maxilla and mandible. It is used for a variety of indications, including for reconstruction after resection of a benign or malignant tumor, osteoradionecrosis, or trauma. The current literature reports outcomes for the fibula free flap across all indications, but there is a paucity of information regarding outcomes when the flap is performed exclusively after resection of malignancy. The authors report a systematic review of the literature and report flap survival rates, flap complications, donor site complications, and systemic complications.

Data sources: PubMed, Embase, CINAHL, and Cochrane Library databases.

Methods: Relevant data extracted included study design, number of included patients, type of maxillary or mandibular defect, total and partial flap necrosis, and other flap complications. Study-level synthesis without meta-analysis (SWiM) was performed due to heterogeneity of data across studies.

Results: Eight studies (n = 340) met criteria. Total flap failure: 20/340 (5.9%) and partial failure: 29/340 (8.5%). Among studies reporting, secondary recipient-site complications occurred in 104/256 (40.6%), donor-site in 51/166 (30.7%), and systemic in 49/210 (23.3%). Thirty-day mortality was 3/151 (2.0%) and recurrence 67/241 (27.8%).

Conclusions: Our findings affirm the high success rates in flap survival and functional restoration, highlighting the robust vascular supply and adaptable soft tissue options offered by the fibula free flap. Moreover, while the incidence of complications is not negligible, the long-term complications regarding donor site morbidity and limb function are rare.