The Perfect Timing-Immediate Versus Delayed Microvascular Reconstruction of the Mandible

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2024 Mar 13

PMID 38473338

Authors

Daniel G E Thiem

Fabia Siegberg

Shankeeth Vinayahalingam

Sebastian Blatt

Maximilian Kruger

Bernd Lethaus

Bilal Al-Nawas

Rudiger Zimmerer

Peer W Kammerer

Affiliations

Soon will be listed here.

Abstract

In this retrospective study, the clinical and economic implications of microvascular reconstruction of the mandible were assessed, comparing immediate versus delayed surgical approaches. Utilizing data from two German university departments for oral and maxillofacial surgery, the study included patients who underwent mandibular reconstruction following continuity resection. The data assessed included demographic information, reconstruction details, medical history, dental rehabilitation status, and flap survival rates. In total, 177 cases (131 male and 46 females; mean age: 59 years) of bony free flap reconstruction (72 immediate and 105 delayed) were included. Most patients received adjuvant treatment (81% with radiotherapy and 51% combined radiochemotherapy), primarily for tumor resection. Flap survival was not significantly influenced by the timing of reconstruction, radiotherapy status, or the mean interval (14.5 months) between resection and reconstruction. However, immediate reconstruction had consumed significantly fewer resources. The rate of implant-supported masticatory rehabilitation was only 18% overall. This study suggests that immediate jaw reconstruction is economically advantageous without impacting flap survival rates. It emphasizes patient welfare as paramount over financial aspects in clinical decisions. Furthermore, this study highlights the need for improved pathways for masticatory rehabilitation, as evidenced by only 18% of patients with implant-supported dentures, to enhance quality of life and social integration.

References

Awad M, Altman A, Elrefai R, Shipman P, Looney S, Elsalanty M . The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the observational studies. J Craniomaxillofac Surg. 2019; 47(4):629-641. DOI: 10.1016/j.jcms.2019.01.037. View

Corbitt C, Skoracki R, Yu P, Hanasono M . Free flap failure in head and neck reconstruction. Head Neck. 2013; 36(10):1440-5. DOI: 10.1002/hed.23471. View

Kansy K, Mueller A, Mucke T, Koersgen F, Wolff K, Zeilhofer H . Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide. J Craniomaxillofac Surg. 2015; 43(8):1364-8. DOI: 10.1016/j.jcms.2015.06.034. View

Lin C, Kang C, Tsao C, Wallace C, Lee L, Lin C . Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy. PLoS One. 2014; 9(4):e94315. PMC: 3983152. DOI: 10.1371/journal.pone.0094315. View

DeSerres J, Barber B, Seikaly H, Harris J, OConnell D . Free Flap Elevation Times in Head and Neck Reconstruction Using the Harmonic Scalpel Shears. Plast Reconstr Surg Glob Open. 2016; 4(5):e718. PMC: 4995721. DOI: 10.1097/GOX.0000000000000740. View

Wong A, Nguyen T, Peric M, Shahabi A, Vidar E, Hwang B . Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery. 2014; 35(1):6-12. DOI: 10.1002/micr.22223. View

Rosado P, Cheng H, Wu C, Wei F . Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck. 2014; 37(4):615-8. DOI: 10.1002/hed.23624. View

Crawley M, Sweeny L, Ravipati P, Heffelfinger R, Krein H, Luginbuhl A . Factors Associated with Free Flap Failures in Head and Neck Reconstruction. Otolaryngol Head Neck Surg. 2019; 161(4):598-604. DOI: 10.1177/0194599819860809. View

Taghizadeh R, Moustaki M, Harris S, Roblin P, Farhadi J . Does post-mastectomy radiotherapy affect the outcome and prevalence of complications in immediate DIEP breast reconstruction? A prospective cohort study. J Plast Reconstr Aesthet Surg. 2015; 68(10):1379-85. DOI: 10.1016/j.bjps.2015.06.003. View

10.

Mucke T, Wolff K, Wagenpfeil S, Mitchell D, Holzle F . Immediate microsurgical reconstruction after tumor ablation predicts survival among patients with head and neck carcinoma. Ann Surg Oncol. 2009; 17(1):287-95. DOI: 10.1245/s10434-009-0758-0. View

11.

Tall J, Bjorklund T, Skogh A, Arnander C, Halle M . Vascular Complications After Radiotherapy in Head and Neck Free Flap Reconstruction: Clinical Outcome Related to Vascular Biology. Ann Plast Surg. 2014; 75(3):309-15. DOI: 10.1097/SAP.0000000000000081. View

12.

Miller H, Bush K, Delancy M, De Leo N, Joshi H, Saracco B . Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2021; 75(2):743-752. DOI: 10.1016/j.bjps.2021.09.050. View

13.

Gielisch M, Siegberg F, Thiem D, Blatt S, Heimes D, Kammerer P . A novel alloplastic grid reconstruction plate for the mandible - Retrospective comparative clinical analysis of failure rates and specific complications. J Craniomaxillofac Surg. 2023; 51(7-8):448-453. DOI: 10.1016/j.jcms.2023.07.005. View

14.

Hanken H, Wilkens R, Riecke B, Al-Dam A, Tribius S, Kluwe L . Is immediate bony microsurgical reconstruction after head and neck tumor ablation associated with a higher rate of local recurrence?. J Craniomaxillofac Surg. 2015; 43(3):373-5. DOI: 10.1016/j.jcms.2015.01.006. View

15.

Rendenbach C, Holterhoff N, Hischke S, Kreutzer K, Smeets R, Assaf A . Free flap surgery in Europe: an interdisciplinary survey. Int J Oral Maxillofac Surg. 2017; 47(5):676-682. DOI: 10.1016/j.ijom.2017.11.013. View

16.

Thiem D, Romer P, Blatt S, Al-Nawas B, Kammerer P . New Approach to the Old Challenge of Free Flap Monitoring-Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure. J Pers Med. 2021; 11(11). PMC: 8625540. DOI: 10.3390/jpm11111101. View

17.

Sams A . HISTOLOGICAL CHANGES IN THE LARGER BLOOD VESSELS OF THE HIND LIMB OF THE MOUSE AFTER X-IRRADIATION. Int J Radiat Biol Relat Stud Phys Chem Med. 1965; 9:165-74. DOI: 10.1080/09553006514550211. View

18.

Goetze E, Moergel M, Gielisch M, Kammerer P . Safety of resection margins in CAD/CAM-guided primarily reconstructed oral squamous cell carcinoma-a retrospective case series. Oral Maxillofac Surg. 2019; 23(4):459-464. DOI: 10.1007/s10006-019-00797-8. View

19.

Schmidt C, Turrini O, Parikh P, House M, Zyromski N, Nakeeb A . Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010; 145(7):634-40. DOI: 10.1001/archsurg.2010.118. View

20.

Kammerer P, Klein M, Moergel M, Gemmel M, Draenert G . Local and systemic risk factors influencing the long-term success of angular stable alloplastic reconstruction plates of the mandible. J Craniomaxillofac Surg. 2013; 42(5):e271-6. DOI: 10.1016/j.jcms.2013.10.004. View