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45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC)

11.09. - 13.09.2014, München

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Outcome analysis of mandibular reconstruction using osteomyocutaneous peroneal artery based combined flap or fibula osteoseptocutaneous

Meeting Abstract

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  • presenting/speaker Emre Gazyakan - Ludwigshafen, Deutschland
  • Christoph Hirche - Ludwigshafen, Deutschland
  • Holger Engel - Klinikum Kassel, Klinik für Plastisch-rekonstruktive, Ästhetische und Handchirurgie, Kassel, Deutschland
  • Ulrich Kneser - Ludwigshafen, Deutschland
  • Ming-Huei Cheng - Chang Gung Memorial Hospital, Department of Plastic & Reconstructive Surgery, Taipei, TAIWAN

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. Österreichische Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie. 45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPRÄC). München, 11.-13.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc337

doi: 10.3205/14dgpraec077, urn:nbn:de:0183-14dgpraec0776

Published: September 3, 2014

© 2014 Gazyakan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: Extensive composite mandibular defects in head and neck cancer patients pose challenging reconstruction dilemmas. Reconstruction can be achieved with the fibula osteoseptocutaneous (OSC) flap, as well as the osteomyocutaneous peroneal artery perforator based combined (OPAC) flap. The aim of this study was twofold: 1) to investigate the occurrence of osteoradionecrosis and plate exposure using both flaps, and 2) to provide an algorithm of when to employ an OPAC flap rather than an OSC flap.

Methods: The medical records of 121 patients who underwent composite mandibular defect reconstruction performed by a single surgeon between 1999 and 2010 were reviewed. Mandible reconstruction was performed using 68 OSC flaps and 53 OPAC flaps.

Results: Acute complications in the OSC group included total flap loss (1.5 percent), partial flap losses (5.9 percent), venous congestions (11.8 percent), and arterial insufficiency (5.9 percent). Acute complications in the OPAC group included total flap loss (3.8 percent), partial flap loss (15.1 percent), venous congestions (15.1 percent), and arterial insufficiency (3.8 percent). The reconstructions with the OPAC flap compared to the OSC flap had significantly lower rates of osteoradionecrosis (9.4 percent, 23.5 percent, p = 0.049) and plate exposure (9.4 percent, 23.5 percent, p = 0.04).

Conclusions: The OPAC flap is associated with a lower rate of osteoradionecrosis and plate exposure than the OSC flap. With its high success rate, the OPAC flap is a reliable flap for reconstructing extensive composite mandibular defects.