Bone Union of Osseous Microvascular Free Tissue Transfer in Mandibular Reconstruction

Akina Tamaki; Shruthi Sethuraman; Lucy Shi; Songzhu Zhao; Keith C Carver; Angel Hatef; Michael Luttrull; Nolan B Seim; Stephen Y Kang; Enver Ozer; Amit Agrawal; Matthew O Old

doi:10.1177/2473974X211070258

Bone Union of Osseous Microvascular Free Tissue Transfer in Mandibular Reconstruction

OTO Open. 2022 Jan 12;6(1):2473974X211070258. doi: 10.1177/2473974X211070258. eCollection 2022 Jan-Mar.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
² Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
³ Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA.
⁴ Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Abstract

Objectives: Osseous microvascular free tissue transfer (MFTT) is the gold standard for reconstruction for most segmental mandibulectomy defects. The most common osseous MFTT utilized in reconstruction is the fibular, scapular, and osteocutaneous radial forearm (OCRF) free flap. We evaluated postoperative bone union as well as clinical complications following MFTT and the impact of various patient and reconstructive characteristics, including type of osseous MFTT.

Study design: Retrospective cohort study.

Setting: Tertiary care academic hospital.

Methods: This study examined patients who underwent osseous MFTT for mandibular defects from January 2017 to January 2019.

Results: An overall 144 osteotomies in 58 patients were evaluated. Of the 144 junctions, 28 (19.4%) showed radiographic nonunion. Patients who underwent preoperative (odds ratio [OR] = 0.30, P = .027) and postoperative (OR = 0.28, P = .003) radiation had a significantly lower bone union score. Time from surgery to postoperative imaging was associated with higher bone union scores (OR = 1.07, P = .024). When bone union scores were compared among types of MFTT, fibular (OR = 5.62, P = .008) and scapular (OR = 4.69, P = .043) MFTT had significantly higher scores than OCRF MFTT. Twelve (20.7%) patients had postoperative complications. There was no statistically significant correlation between clinical complications and various variables, including type of osseous MFTT.

Conclusion: Pre- and postoperative radiation and time from surgery have an impact on bone union. Regarding the type of MFTT, fibular and scapular MFTT appeared to have higher bone union when compared with OCRF. There was no impact of bone union or type of osseous MFTT on clinical complications.

Keywords: bone union; microvascular free tissue transfer; segmental mandibulectomy.