TY - JOUR
T1 - Post-operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps
AU - Head and Neck Reconstruction Group
AU - Slijepcevic, Allison A.
AU - Wax, Mark K.
AU - Hanasono, Matthew
AU - Ducic, Yadranko
AU - Petrisor, Daniel
AU - Thomas, Carissa M.
AU - Shnayder, Yelizaveta
AU - Kakarala, Kiran
AU - Pipkorn, Patrik
AU - Puram, Sidharth V.
AU - Rich, Jason
AU - Rezaee, Rod
AU - Pittman, Amy
AU - Troob, Scott
N1 - Publisher Copyright:
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2023/2
Y1 - 2023/2
N2 - Educational Objective: Assess outcomes of pediatric facial reconstruction with fibula free flaps. Objectives: Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post-operative complications, donor site morbidity, impact on craniofacial growth, and oro-dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps. Study Design: Retrospective chart review. Methods: Multi-institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps. Results: Eighty-seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long-term hardware exposure, greater than 3 months following reconstruction. Short-term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long-term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long-term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post-operative speech outcomes showed 94% with fully intelligible speech. Conclusion: Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long-term follow-up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post-operative gait abnormality is rare. Level of Evidence: 3 Laryngoscope, 133:302–306, 2023.
AB - Educational Objective: Assess outcomes of pediatric facial reconstruction with fibula free flaps. Objectives: Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post-operative complications, donor site morbidity, impact on craniofacial growth, and oro-dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps. Study Design: Retrospective chart review. Methods: Multi-institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps. Results: Eighty-seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long-term hardware exposure, greater than 3 months following reconstruction. Short-term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long-term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long-term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post-operative speech outcomes showed 94% with fully intelligible speech. Conclusion: Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long-term follow-up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post-operative gait abnormality is rare. Level of Evidence: 3 Laryngoscope, 133:302–306, 2023.
KW - fibula free flap
KW - microvascular reconstruction
KW - pediatric facial reconstruction
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U2 - 10.1002/lary.30219
DO - 10.1002/lary.30219
M3 - Article
C2 - 35656557
AN - SCOPUS:85133878292
SN - 0023-852X
VL - 133
SP - 302
EP - 306
JO - Laryngoscope
JF - Laryngoscope
IS - 2
ER -