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Analysis of 50 Consecutive Flaps

Thomas Shpitzer, MD; Peter C. Neligan, MD; Patrick J. Gullane, MD; Jeremy E. Freeman, MD; Brian J. Boyd, MD; Lorne E. Rotstein, MD; Dale H. Brown, MD; Jonathan C. Irish, MD; Eyal Gur, MD

Arch Otolaryngol Head Neck Surg. 1997;123(9):939-944.

Abstract
Objective
To evaluate the results and functional outcome associated with fibular free flap reconstruction of orofacial and mandibular defects.

Design
We conducted a retrospective analysis of 50 consecutive fibular free flaps during a 3-year period. Forty patients were available for follow-up, which ranged from 4 to 39 months.

Setting
Academic tertiary care referral medical center.

Patients
Fifty consecutive mandibular reconstructions using the fibular free flap were performed on 47 patients. Thirty-five patients (74%) underwent primary reconstruction. Sixty-six percent of the mandibular defects were anterior or combined anterolateral types; the remainder were pure lateral defects. In 38 patients (81%), a skin paddle was included with the flap to provide either a mucosal lining or skin cover, whereas in only 9 patients (19%), bone was used alone.

Main Outcome Measures
Factors reflecting functional properties and processes as well as complications of the upper aerodigestive tract were evaluated clinically and radiographically.

Results
Four flaps required reexploration as emergencies, and none were successfully salvaged (8.5% failure). Three patients underwent further free vascularized fibula transfer with 1 failure. During follow-up, swallowing was normal in 25 patients (64%), oral continence was normal or almost normal in 26 patients (67%), and speech was normal or easily intelligible in 35 patients (90%). Aesthetic results were excellent or acceptable in 37 patients (95%).

Conclusions
Our results reveal that the vascularized fibular free flap is very suitable with an excellent success rate for reconstructing both the composite or simple long-spanned mandibular defect. The overlying skin island is reliable and provides lining or coverage for intraoral and extraoral defects. Superior functional and cosmetic results are expected in the majority of patients, while donor site morbidity is minimal.

Arch Otolaryngol Head Neck Surg. 1997;123:939-944

Author Affiliations
From the Division of Plastic Surgery (Drs Shpitzer, Neligan, Boyd, and Gur), the Departments of Otolaryngology (Drs Gullane, Brown, and Irish) and General Surgery (Dr Rotstein), The Toronto Hospital Head and Neck Program, and the Department of Otolaryngology, Mount Sinai Hospital Head and Neck Oncology Program, University of Toronto (Dr Freeman), Toronto, Ontario.

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