Floor plan - 2013 Annual Meeting - American Association for Hand ...

Does the Ischemia Time Affect the Outcome of Free Fibula Flaps for Head and Neck
Reconstruction? A Review of 117 Fibular Flaps
Institution where the work was prepared: Chang Gung Memorial Hospital, Tao-yuan, Taipeh, Taiwan
Shu-ying Chang, MD; Huang-Kai Kao, MD; Jung-Ju Huang, MD; Holger Engel, MD; Betul Ulusal; Ming-Huei Cheng,
MD, PhD; Chang Gung Memorial Hospital
INTRODUCTION:
Fibula osteocutaneous flap is a good option for reconstruction of segmental mandibular defect. The ischemia time of fibula flap for
mandibular reconstruction is variable according to surgeon's experiences, osteotomies of fibula and fixation of fibula before vs. after
division of the pedicle, anastomosis before vs. after inset of the flap, and artery vs. vein anastomosis first. The purposes of this study
were to investigate the relations between the ischemia time and the outcome of fibula flap including bone and skin paddle, and to
establish the upper limit of ischemia time for fibula flap.
MATERIALS/METHODS:
Between February of 2003 and March of 2005, 117 fibula flaps were used for mandibular reconstructions. The outcome was compared
in the success rate and the complication rate among different ischemia time, 1~3 (n=29), 3~4 (n=51), 4~5 (n=23), 5~7(n=14) hours
groups. The complications were defined as three categories: acute complications (within a week postoperatively); subacute complications
(between a week and one month postoperatively); and chronic complications (one month after operation).
RESULTS:
The mean ischemia time was 3.6 hours (ranged from 1 to 6.6 hours). The patient's risk factors including smoking, diabetes, pre-operative
radiotherapy, and cancer stage were not statistically different between each group. The re-exploration rate was 7.7%. Mean flap success
rate was 98.3%. Mean partial flap loss rate was 17.1% (ranged from 7.8 to 100 %). There was statistical difference between the ischemia
time shorter and longer than 5 hours groups (P=0.035). There was no statistically significant difference among the 4 groups in success
rate and complication rates in different stages. The number of osteotomies (0~3) of fibula bone did not significantly affect the success
rate, complication (acute, subacute, chronic and overall complications ) rates, partial flap loss rate, and bone loss rate in this series.
DISCUSSION:
Although the ischemia time of fibula flap is critical for the microsurgical mandibular reconstruction, surgeons may spend a little more
time for shaping the fibula to mandible or even adding the osseointegrated dental implants if the longer ischemia time does not compromise
the outcome of this procedure. In conclusion, the longer ischemia time of fibula flap for mandibular reconstruction does not
affect the success and complication rates. We suggest the ischemia time of fibula osteocutaneous flap for mandibular reconstruction
is better limited to 5 hours to reduce the partial flap loss.
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