Reconstructing Segmental Mandibular Defects: A Single-Center, 21-Year Experience with 413 Fibula Free Flaps.
Publication/Presentation Date
10-9-2025
Abstract
BACKGROUND: The fibula free flap (FFF) is a common choice for mandibular reconstruction after post-oncologic resection. Advances in technology and surgical technique have changed the workflow of FFF-based mandible reconstruction. This study characterizes the institutional experience with these changes and their impact on patient outcomes.
METHODS: A 21-year retrospective review was performed of patients who underwent segmental mandibulectomy with FFF-based reconstruction.
RESULTS: 401 patients underwent reconstruction with 413 free flaps with a median follow-up period of 2.9 years. Over the study period, there was an upward trend in case volume with an average procedure length of 675.6 ± 132.5 minutes. Mini-plates (n=340, 82.3%) were most commonly used for flap fixation, but reconstruction bars (n=73, 17.7%) later became the preferred fixation method. 168 (40.7%) patients had surgical planning with computer-aided design and manufacturing (CAD/CAM). 98 (23.7%) patients underwent immediate dental implant placement (IDIP). As CAD/CAM and IDIP became more prevalent during the study period, dental rehabilitation rates increased. 226 (54.7%) patients experienced a complication at the recipient site, of which 122 (29.5%) required operative management; the rate of complications showed no discernable trend during the study period. The overall flap success rate of this cohort was 97.8% with an all-cause mortality rate of 43.6%.
CONCLUSION: This study presents an institutional series of FFF-based mandible reconstruction in the 21st century. Advances in surgical technique and technology have improved operative workflow and patient outcomes; however, post-oncologic mandible reconstruction remains a highly morbid procedure.
ISSN
1529-4242
Published In/Presented At
Allen, R. J., Jr, Zhang, K. K., Cohen, Z., Shahzad, F., Nelson, J. A., McCarthy, C. M., Patel, S. G., Boyle, J. O., Shah, J. P., Disa, J. J., Cordeiro, P. G., Mehrara, B. J., & Matros, E. (2025). Reconstructing Segmental Mandibular Defects: A Single-Center, 21-Year Experience with 413 Fibula Free Flaps. Plastic and reconstructive surgery, 10.1097/PRS.0000000000012516. Advance online publication. https://doi.org/10.1097/PRS.0000000000012516
Disciplines
Medicine and Health Sciences
PubMedID
41159801
Department(s)
Fellows and Residents
Document Type
Article