Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects

A two-stage approach with temporary orocutaneous fistula

Pedro Ciudad, Tony Chieh Ting Huang, Oscar J. Manrique, Mouchammed Agko, Kian Adabi, Fabio Nicoli, Bülent Saçak, Kidakorn Kiranantawat, Steven L. Moran, Hung Chi Chen

Research output: Contribution to journalArticle

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 cm 2 (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.

Original languageEnglish (US)
Pages (from-to)234-240
Number of pages7
JournalMicrosurgery
Volume39
Issue number3
DOIs
StatePublished - Mar 1 2019

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Fibula
Fistula
Skin
Hematoma
Mucous Membrane
Hyperemia
Length of Stay
Necrosis
Neck
Demography
Tissue Donors
Transplants

ASJC Scopus subject areas

  • Surgery

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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. / Ciudad, Pedro; Huang, Tony Chieh Ting; Manrique, Oscar J.; Agko, Mouchammed; Adabi, Kian; Nicoli, Fabio; Saçak, Bülent; Kiranantawat, Kidakorn; Moran, Steven L.; Chen, Hung Chi.

In: Microsurgery, Vol. 39, No. 3, 01.03.2019, p. 234-240.

Research output: Contribution to journalArticle

Ciudad, P, Huang, TCT, Manrique, OJ, Agko, M, Adabi, K, Nicoli, F, Saçak, B, Kiranantawat, K, Moran, SL & Chen, HC 2019, '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, pp. 234-240. https://doi.org/10.1002/micr.30386
Ciudad, Pedro ; Huang, Tony Chieh Ting ; Manrique, Oscar J. ; Agko, Mouchammed ; Adabi, Kian ; Nicoli, Fabio ; Saçak, Bülent ; Kiranantawat, Kidakorn ; Moran, Steven L. ; Chen, Hung Chi. / Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects : A two-stage approach with temporary orocutaneous fistula. In: Microsurgery. 2019 ; Vol. 39, No. 3. pp. 234-240.
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title = "Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula",
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 cm 2 (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.",
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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

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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 cm 2 (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.

AB - 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 cm 2 (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.

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