Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, U.S.A.
Manhattan Maxillofacial Surgery, New York, New York, U.S.A.
Laryngoscope. 2022 Aug;132(8):1576-1581. doi: 10.1002/lary.29927. Epub 2021 Nov 27.
OBJECTIVES/HYPOTHESIS: Fibula flaps are routinely used for osseous reconstruction of head and neck defects. However, single-barrel fibula flaps may result in a height discrepancy between native mandible and grafted bone, limiting outcomes from both an aesthetic and dental standpoint. The double-barrel fibula flap aims to resolve this. We present our institution's outcomes comparing both flap designs.
Retrospective cohort study.
We conducted a retrospective review of all patients undergoing free fibula flap mandibular reconstruction at our institution between October 2008 and October 2020. Patients were grouped based on whether they underwent single-barrel or double-barrel reconstruction. Postoperative outcomes data were collected and compared between groups. Differences in categorical and continuous variables were assessed using a Chi-square test or Student's t-test, respectively.
Out of 168 patients, 126 underwent single-barrel and 42 underwent double-barrel reconstruction. There was no significant difference in postoperative morbidity between approaches, including total complications (P = .37), flap-related complications (P = .62), takeback to the operating room (P = .75), flap salvage (P = .66), flap failure (P = .45), and mortality (P = .19). In addition, there was no significant difference in operative time (P = .86) or duration of hospital stay (P = .17). After adjusting for confounders, primary dental implantation was significantly higher in the double-barrel group (odds ratio, 3.02; 95% confidence interval, 1.2-7.6; P = .019).
Double-barrel fibula flap mandibular reconstruction can be performed safely without increased postoperative morbidity or duration of hospital stay relative to single-barrel reconstruction. Moreover, the double-barrel approach is associated with higher odds of primary dental implantation and may warrant further consideration as part of an expanded toolkit for achieving early dental rehabilitation.
3 Laryngoscope, 132:1576-1581, 2022.
目的/假设：腓骨瓣常用于头颈部缺损的骨重建。然而，单筒腓骨瓣可能导致原生下颌骨和移植骨之间存在高度差异，从美学和牙科角度限制了结果。双筒腓骨瓣旨在解决这个问题。我们展示了我们机构比较两种瓣设计的结果。
回顾性队列研究。
我们对 2008 年 10 月至 2020 年 10 月期间在我们机构接受游离腓骨瓣下颌骨重建的所有患者进行了回顾性审查。根据他们接受单筒还是双筒重建，将患者分为两组。收集并比较组间术后结果数据。使用卡方检验或学生 t 检验分别评估分类和连续变量之间的差异。
在 168 例患者中，126 例行单筒重建，42 例行双筒重建。两种方法的术后发病率无显著差异，包括总并发症（P=.37）、瓣相关并发症（P=.62）、返回手术室（P=.75）、瓣挽救（P=.66）、瓣失败（P=.45）和死亡率（P=.19）。此外，手术时间（P=.86）和住院时间（P=.17）也无显著差异。在调整混杂因素后，双筒组的原发性牙种植显著更高（比值比，3.02；95%置信区间，1.2-7.6；P=.019）。
与单筒重建相比，双筒腓骨瓣下颌骨重建可以安全进行，不会增加术后发病率或住院时间。此外，双筒方法与原发性牙种植的可能性更高相关，可能值得进一步考虑作为实现早期牙科康复的扩展工具包的一部分。
3.《喉镜》，132：1576-1581，2022。
