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Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula.
Microsurgery. 2019 Mar; 39(3):234-240.M

Abstract

INTRODUCTION

Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable two-stage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions.

METHODS

From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded.

RESULTS

The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm2 (range 300-504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss.

CONCLUSION

Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.

Authors+Show Affiliations

National Cancer Institute of Peru (INEN), Department of Plastic Surgery, Lima, Peru. Arzobispo Loayza National Hospital, Department of Plastic and Burn Surgery, Lima, Peru. Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan.Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.Section of Plastic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, USA.Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan.Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan.Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan.Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.Department of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30496605

Citation

Ciudad, Pedro, et al. "Optimizing Survival of Large Fibula Osteocutaneous Flaps for Extensive Full-thickness Oromandibular Defects: a Two-stage Approach With Temporary Orocutaneous Fistula." Microsurgery, vol. 39, no. 3, 2019, pp. 234-240.
Ciudad P, Huang TC, Manrique OJ, et al. Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula. Microsurgery. 2019;39(3):234-240.
Ciudad, P., Huang, T. C., Manrique, O. J., Agko, M., Adabi, K., Nicoli, F., Saçak, B., Kiranantawat, K., Moran, S. L., & Chen, H. C. (2019). Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula. Microsurgery, 39(3), 234-240. https://doi.org/10.1002/micr.30386
Ciudad P, et al. Optimizing Survival of Large Fibula Osteocutaneous Flaps for Extensive Full-thickness Oromandibular Defects: a Two-stage Approach With Temporary Orocutaneous Fistula. Microsurgery. 2019;39(3):234-240. PubMed PMID: 30496605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula. AU - Ciudad,Pedro, AU - Huang,Tony Chieh-Ting, AU - Manrique,Oscar J, AU - Agko,Mouchammed, AU - Adabi,Kian, AU - Nicoli,Fabio, AU - Saçak,Bülent, AU - Kiranantawat,Kidakorn, AU - Moran,Steven L, AU - Chen,Hung-Chi, Y1 - 2018/11/29/ PY - 2018/02/02/received PY - 2018/06/21/revised PY - 2018/09/14/accepted PY - 2018/11/30/pubmed PY - 2019/10/2/medline PY - 2018/11/30/entrez SP - 234 EP - 240 JF - Microsurgery JO - Microsurgery VL - 39 IS - 3 N2 - INTRODUCTION: Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable two-stage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. METHODS: From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded. RESULTS: The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm2 (range 300-504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss. CONCLUSION: Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap. SN - 1098-2752 UR - https://www.unboundmedicine.com/medline/citation/30496605/Optimizing_survival_of_large_fibula_osteocutaneous_flaps_for_extensive_full_thickness_oromandibular_defects:_A_two_stage_approach_with_temporary_orocutaneous_fistula_ L2 - https://doi.org/10.1002/micr.30386 DB - PRIME DP - Unbound Medicine ER -