ASSESSING FUNCTIONAL OUTCOMES IN POST ONCOLOGICAL RECONSTRUCTION OF THE MANDIBLE WITH A FREE FIBULA FLAP
DOI:
https://doi.org/10.71000/ssa1rs28Keywords:
Fibula Free Flap, Mandibular Reconstruction, , Oncologic Surgery, Oral Function, Postoperative Recovery, Quality of Life, Surgical OutcomesAbstract
Background: Mandibular defects following oncologic resections present significant challenges in restoring both form and function. The free fibula flap (FFF) has emerged as the gold standard for oromandibular reconstruction due to its versatility, reliability, and ability to support vascularized bone and soft tissue transfer. Early functional outcomes provide critical insight into recovery trajectories, yet are often underreported, particularly within the initial six weeks post-surgery. This study aims to address that gap through early outcome assessment.
Objective: To evaluate early postoperative functional outcomes in patients undergoing oncological mandibular reconstruction using a free fibula flap.
Methods: This longitudinal, prospective study was conducted at the Department of Plastic Surgery, Shifa International Hospital, Islamabad, over a minimum period of three months. A total of 30 patients aged 18–80 years undergoing mandibular reconstruction with FFF were enrolled using non-probability consecutive sampling. Functional outcomes were assessed six weeks postoperatively using the Rogers 11-item clinical scoring system (range: 0–29), with scores categorized as unsatisfactory (0–11), satisfactory (12–17), good (18–23), and excellent (24–29). Data were analyzed using SPSS v26.0, with p-values <0.05 considered statistically significant.
Results: The mean patient age was 54.3 ± 11.2 years, and the male-to-female ratio was 2:1. The average defect size reconstructed was 7.8 ± 1.3 cm, and the mean Rogers score was 21.6 ± 4.1. A total of 46.6% of patients had good outcomes, 26.6% excellent, 20% satisfactory, and 6.7% unsatisfactory. Modified diet was required in 66.66% of patients, and 86.6% exhibited no drooling. Significant associations were found between functional scores and tumor type and defect size (p = 0.01).
Conclusion: Free fibula flap reconstruction offers favorable early functional outcomes in patients undergoing mandibular reconstruction post-oncologic resection. These findings affirm the FFF as a reliable technique for restoring mandibular function and patient quality of life.
References
Kreutzer K, Steffen C, Nahles S, Koerdt S, Heiland M, Rendenbach C, et al. Removal of patient-specific reconstruction plates after mandible reconstruction with a fibula free flap: is the plate the problem? Int J Oral Maxillofac Surg. 2022;51(2):182-90.
Muhammad W, Khan MM, Zafar S, Alqutub MN, AlMubarak AM, Mokeem S, et al. Assessment of unstimulated whole salivary tumor necrosis factor alpha (TNF-α) and cellular micronuclei levels in snuff (Naswar) users and non-users for early diagnosis of oral squamous cell carcinoma. Int J Environ Res Public Health. 2021;18(14):7213.
Khan MF, Hayhoe RP, Kabir R. Exploring the risk factors for oral cancer in Pakistan: a systematic literature review. Dent J. 2024;12(2):25-30.
Ahmad M, Khan ZA, Khan TU, Alqutub MN, Mokeem SA, AlMubarak AM, et al. Influence of surgical flap design (Envelope and Szmyd) for removal of impacted mandibular third molars on clinical periodontal parameters: a clinical trial. Int J Environ Res Public Health. 2021;18(9):4465.
Barr ML, Haveles CS, Rezzadeh KS, Nolan IT, Castro R, Lee JC, et al. Virtual surgical planning for mandibular reconstruction with the fibula free flap: a systematic review and meta-analysis. Ann Plast Surg. 2020;84(1):117-22.
Pamias-Romero J, Saez-Barba M, de-Pablo-García-Cuenca A, Vaquero-Martínez P, Masnou-Pratdesaba J, Bescós-Atín C. Quality of life after mandibular reconstruction using free fibula flap and customized plates: a case series and comparison with the literature. Cancers (Basel). 2023 Apr 30;15(9):25-82.
Atallah S, Bozec A, Ransy P, Davrou J, Longis J, Humbert M, Brenet E, Schultz P, Damecourt A, Saint Guily JL, Baujat B. Functional evaluation of mandibular reconstruction with bone free flap. A GETTEC study. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2021 Mar 1;138(2):82-8.
Pamias-Romero J, Saez-Barba M, de-Pablo-García-Cuenca A, Vaquero-Martínez P, Masnou-Pratdesaba J, Bescós-Atín C. Quality of life after mandibular reconstruction using free fibula flap and customized plates: a case series and comparison with the literature. Cancers. 2023 Apr 30;15(9):2582.
Walatek J, Myśliwiec A, Krakowczyk Ł, Wolański W, Lipowicz A, Dowgierd K. Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review. European Journal of Medical Research. 2023 Sep 28;28(1):386.
Trilles J, Chaya BF, Daar DA, Anzai L, Boczar D, Rodriguez Colon R, et al. Double-Barrel Versus Single-Barrel Fibula Flaps for Mandibular Reconstruction: Safety and Outcomes. Laryngoscope. 2022;132(8):1576-81.
Sun J, Li J, Lv MM, Wang L, Gupta A, Shen Y. Expanded Transoral Microvascular Mandibular Reconstruction: A Scar-Free Approach. J Oral Maxillofac Surg. 2022;80(6):1115-26.
Piotrowska-Seweryn A, Szymczyk C, Walczak DA, Krakowczyk Ł, Maciejewski A, Hadasik G, et al. Fibular Free Flap and Iliac Crest Free Flap Mandibular Reconstruction In Patients With Mandibular Ameloblastomas. J Craniofac Surg. 2022;33(7):1962-70.
Lai YS, Lai YH, Lee YC. Impact of fibula osteoseptocutaneous flap laterality in mandibular and intraoral reconstruction. J Plast Reconstr Aesthet Surg. 2023;86:199-204.
Steffen C, Soares AP, Heintzelmann T, Fischer H, Voss JO, Nahles S, et al. Impact of the adjacent bone on pseudarthrosis in mandibular reconstruction with fibula free flaps. Head Face Med. 2023;19(1):43.
Liu S, Zhang WB, Wang Y, Mao C, Yu GY, Peng X. Long-Term Outcomes after Pediatric Mandibular Reconstruction Using Vascularized Free Fibula Flap. Plast Reconstr Surg. 2024;153(2):397e-406e.
Yim NH, Montgomery A, Upadhyaya RM, Buchanan EP. Long-Term Update: Free Fibula Flap Growth After Pediatric Mandibular Reconstruction. J Craniofac Surg. 2023;34(3):1027-30.
Barton BM, Mamdani M, Lumley C, Blumberg J, Huang BY, Patel SN. Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction. Laryngoscope. 2023;133(10):2597-602.
Panesar K, Markiewicz MR, Best D, Lee KC, Edwards S, Susarla SM. Pediatric Mandibular Reconstruction. Atlas Oral Maxillofac Surg Clin North Am. 2023;31(2):177-86.
Ritschl LM, Mücke T, Hart D, Unterhuber T, Kehl V, Wolff KD, et al. Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study. Clin Oral Investig. 2021;25(5):2905-14.
Rao D, Weyh A, Bunnell A, Hernandez M. The Role of Imaging in Mandibular Reconstruction with Microvascular Surgery. Oral Maxillofac Surg Clin North Am. 2023;35(3):327-44.
Lubamba GP, Ma Z, Huang G, Men Y, Zhu G, Zhang G, et al. Segmental mandibulectomy and microvascular reconstruction with fibula free flap: Comparison between intraoral and extraoral approaches. J Plast Reconstr Aesthet Surg. 2024;97:33-40.
Liu S, Zhang WB, Yu Y, Mao C, Yu GY, Peng X. Symmetrical Midfacial Growth After Pediatric Mandibular Reconstruction With Free Fibula Flap. J Oral Maxillofac Surg. 2023;81(12):1594-605.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Shahrukh Mohmand, Mamoon Rashid, Saad Ur Rehman Sarwar, Muhammad Ibrahim Khan, Rafia Masud, Fatima Askari (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
