Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction

To evaluate perioperative complications in a homogeneous cohort undergoing microvascular osteocutaneous free flap (OCFF) reconstruction following segmental mandibulectomy for advanced oral cancer and to identify the causes of late OCFF failures.

Retrospective chart review.

The records of 65 adults who underwent a segmental mandibulectomy for primary oral cavity cancer followed by single-stage reconstruction OCFF were reviewed. Early and late complications were identified and their associations to patients' independent variables and to each other were analyzed to assess etiologic causes of late OCFF failure.

The incidence of early and late complications mirrored each another at 29%, and a 95% early-success rate was achieved. An early complication did predict an early infection (odds ratio [OR], 63.3; 95% confidence interval [CI], 6.8-585.3). Furthermore, an early perioperative infection impacted the incidence of late complications (OR, 4.8; 95% CI, 1.3-18.3), and moreover severely impacted the incidence of osteomyelitis/osteoradionecrosis (OR, 8.8; 95% CI, 1.8-41.9) and late failures (OR, 12.8; 95% CI, 1.9-84.5).

Mandibular reconstruction following segmental mandibulectomy provides immediate restoration but is often plagued with perioperative complications that are difficult to predict. Early perioperative infections impact patient long-term morbidity by increasing the risk of late graft failure by almost 13-fold. Consequently, it is felt that early aggressive treatment of these infections may reduce the incidence and severity of late complications and improve patient outcomes.