The team concept in mandibular reconstruction after ablative oncologic surgery.

Area of Science:

• Oral and Maxillofacial Surgery
• Microsurgery
• Health Economics

Background:

• Mandibular reconstruction presents significant challenges in terms of surgical complexity and cost.
• Free fibula flaps are a common method for mandibular reconstruction, but optimizing their efficiency is crucial.

Purpose of the Study:

• To evaluate the efficiency and cost-effectiveness of a reconstructive team approach for mandibular reconstruction.
• To compare outcomes between early and later patient cohorts undergoing free fibula flap reconstruction.

Main Methods:

• Retrospective review of 64 patients undergoing microvascular fibular reconstruction of the mandible.
• Analysis of operating room time, blood product usage, fluid replacement, and hospital/ICU stay.
• Patients divided into two chronological groups (34 in Group 1, 30 in Group 2).

Main Results:

• Group 2 demonstrated significantly shorter operating room time (P < .0001) and hospital stay (P = .012).
• Group 2 used significantly less blood (P = .002) and colloid (P = .044), resulting in cost savings of $5,061.47 per patient.
• No significant differences in demographic factors or wound complications were observed between groups.

Conclusions:

• Development of a team concept and accumulated experience significantly decreased the cost of mandibular reconstruction with free fibula flaps.
• The team approach enhances efficiency and cost-effectiveness without compromising patient safety or increasing wound complications.