An Analysis of Volume, Length and Segmentation of Free Fibula Flap in Reconstruction of the Jaws: Investigation of Their Role on Flap Failure
Mattia Di Bartolomeo,
Irene Laura Lusetti,
Massimo Pinelli,
Sara Negrello,
Arrigo Pellacani,
Stefano Angelini,
Luigi Chiarini,
Riccardo Nocini,
Giorgio De Santis,
Alexandre Anesi
Affiliations
Mattia Di Bartolomeo
Surgery, Dentistry, Maternity and Infant Department, Unit of Dentistry and Maxillo-Facial Surgery, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
Irene Laura Lusetti
Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, 41124 Modena, Italy
Massimo Pinelli
Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, 41124 Modena, Italy
Sara Negrello
Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, 41124 Modena, Italy
Arrigo Pellacani
Surgery, Dentistry, Maternity and Infant Department, Unit of Dentistry and Maxillo-Facial Surgery, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
Riccardo Nocini
Section of Ear Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
Giorgio De Santis
Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, 41124 Modena, Italy
Alexandre Anesi
Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2–21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1–4), with a mean length of 2.52 cm and a mean volume was 3.37 cm3. Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed.
