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J Reconstr Microsurg
DOI: 10.1055/a-2555-2169
Original Article

Risk Factors for Flap Loss in Midface Reconstruction with Vascularized Fibular Flap

Authors

  • Katsuhiro Ishida 

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Yohjiro Makino

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Keita Kishi

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Hiroki Kodama

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Haruyuki Hirayama

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Doruk Orgun

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Masaki Nukami

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Taisuke Akutsu

    2   Department of Otolaryngology, Head and Neck Surgery, Jikei University School of Medicine, Tokyo, Japan

  • Takeshi Miyawaki

    1   Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan

Funding None.
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Abstract

Background

Midface reconstruction should address both functional and cosmetic aspects. The vascularized fibular osteomyocutaneous flap (VFOF) is a promising first choice because of its numerous advantages in this type of reconstruction.

Methods

This study aimed to investigate the causes of VFOF failure during midface reconstruction. We retrospectively reviewed patients who underwent midface defect reconstruction using VFOF from August 2011 to May 2022 at a single center. The primary outcome variable was VFOF loss within 30 days, and secondary outcomes included late complications related to VFOF occurring at least 6 months postoperatively.

Results

A total of 62 patients underwent VFOF reconstruction for midface defects. The VFOF technique was primarily used in 56 (90.3%) patients for initial reconstruction. according to the Brown and Shaw classification, most reconstructions were performed for Class III (77.4%) and Class b (83.6%) defects. Skin paddles of the VFOF were used in 51 (82.3%) patients, and a double flap technique utilizing the fibular was employed in 24 (38.7%) patients. VFOF failure occurred in 10 (16.1%) patients. Prognostic factors associated with VFOF failure included sex (p = 0.01) and maxillary Brown and Shaw classification (horizontal; p = 0.01). Long-term follow-up of 47 patients revealed late complications in 11 (23.4%) patients, and diabetes mellitus was identified as a significant risk factor (p < 0.01).

Conclusion

The VFOF is suitable for midface defect reconstruction; however, proper placement of the fibular bone, avoiding pedicle vessel kinking, ensuring tension-free vascular anastomosis during surgery, considering the use of an additional flap in addition to the fibula flap for large defects, and diligent postoperative nasal care are essential.

Keywords

fibular flap - maxillectomy - midface defect

Registry Information

Registry name: A retrospective study of early and late complications of fibula flap reconstruction after midface defects; registration identification number: UMIN000054486; and registry URL: https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000062238.


Ethical Approval

This study was conducted in accordance with the Declaration of Helsinki and was approved by the independent ethics committee and institutional review board of our university (IRB number 35-251 [118800]). All authors have read and agreed to the submitted version of the manuscript.




Publication History

Received: 02 October 2024

Accepted: 19 February 2025

Accepted Manuscript online:
11 March 2025

Article published online:
27 March 2025

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