Retrospective Study Of Vascularized Free Fibula Flap For Mandibular Reconstruction

Objective: To summarize the clinical experience of repairing mandibular defects with vascularized free fibula flap and analyze possible causes and preventive measures of postoperative complications.Method: A retrospective analysis of 14 patients who were treated vascularized free fibula flap to repair mandible defects at the Department of Oral Maxillofacial Surgery,Yijishan Hospital,First Affiliated Hospital of Wannan Medical College from September 2017 to December 2019.The collected records included the patients information collection,surgical records,postoperative follow-up of 6 to 24 months(by outpatient clinical review,telephone follow-up,imaging examination and subjective evaluation of patients),The above data were analyzed to explore the postoperative complications in the recipient and donor area,and the causes of postoperative complications from the aspects of preoperative preparation,intraoperative conditions,and postoperative management,and put forward corresponding preventive measures.Results: All(1)14 patients completed the operation successfully,and the fibula flap survived.The incidence of infection of the fibula flap after transplantation was 14%.The incidence of vascular crisis of the fibula flap after transplantation was 7%.The primary healing was 86% and the secondary healing was 14% in the receiving area.(2)Postoperative pitting edema of the lower extremity of the donor foot was 7%;occasional pain in the ankle joint was 29%;ankle instability was 7%;skin numbness was 21%.The Enneking lower limb function rating scale included limb pain,functional activity,self-perception,brace use,walking function and gait change,and the mean scores were respectively 4.71,4.21,3.78,4.93,4.57 and 4.71 。(3)Panoramic photographs were taken at follow-up 6-24 months after surgery.The graft fibula and mandibular stump formed epiphysis,and the density of bone cortex increased:presenting as bone remodeling image.(4)Fonseca memory index score: no TMD accounted for 79%,mild TMD accounted for 21%.Conclusion:(1)The vascularized free fibula flap can better repair mandibular defects,the flap has a high survival rate,and can restore the patient’s maxillofacial morphology and oral function,which has high clinical application value.(2)Complications of the vascularized free fibula flap after surgery were mainly infection and vascular crisis.(3)After vascularized free fibula flap,the lower limb function recovered well,the walking function was barrier-free,and the complications in the donor area were mild.The main problem of the patient is sensory disturbance and occasional pain.Long-term complications need further clinical research.(4)This study simply evaluates TMJ function and the postoperative patients have no obvious TMD.Considering the appearance of mild TMD is related to changes in postoperative patients’ mental state.For other causes and preventive measures,further big data long-term clinical the study is still needed.