van Gemert Johannes T M, Abbink Jan H, van Es Robert J J, Rosenberg Antoine J W P, Koole Ron, Van Cann Ellen M
Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
J Surg Oncol. 2018 Mar;117(4):773-780. doi: 10.1002/jso.24976. Epub 2018 Feb 15.
Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia.
Seventy-nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N-stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention.
Sixty-nine (87%) of the 79 fibula flaps were successful at the last follow-up. Forty-eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1-20, P = 0.01). Twenty-nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0-8.3, P = 0.05).
Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications.
评估游离腓骨瓣下颌骨重建情况。确定与主要受区并发症相关的因素，即需要在全身麻醉下进行手术干预的因素。
纳入79例重建病例。分析以下因素：固定类型、截骨数量、缺损部位（双侧/单侧）、外科医生、性别、美国麻醉医师协会（ASA）分级、持续吸烟、病理N分期、年龄、缺损大小、皮瓣缺血时间及术后放疗。采用比例风险回归分析重建与干预之间的时间影响因素。
79例腓骨瓣中有69例（87%）在最后一次随访时成功。41例重建病例发生了48次主要受区并发症。19例并发症在六周内需要手术干预，且大多为血管问题，需要立即干预。这些早期并发症与跨越中线的缺损有关，估计相对风险为5.3（置信区间1.1 - 20，P = 0.01）。29例并发症在重建后6周以上需要手术干预。这些晚期并发症通常在数月或数年后发生，与吸烟有关，估计相对风险为2.8（置信区间1.0 - 8.3，P = 0.05）。
与单侧重建相比，跨越中线的腓骨瓣发生早期主要受区并发症的风险更高。吸烟会增加晚期并发症的风险。
