Double-Barrel Versus Single-Barrel Fibula Flaps for Mandibular Reconstruction: Safety and Outcomes.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Fibula flaps are standard for head and neck osseous reconstruction.
• Single-barrel fibula flaps can lead to height discrepancies, affecting aesthetics and dental outcomes.
• The double-barrel fibula flap is designed to address these limitations.

Purpose of the Study:

• To compare the outcomes of single-barrel versus double-barrel fibula flap mandibular reconstruction.
• To evaluate postoperative morbidity, operative time, and hospital stay.
• To assess the impact on primary dental implantation rates.

Main Methods:

• Retrospective cohort study of 168 patients undergoing free fibula flap mandibular reconstruction (October 2008 - October 2020).
• Patients were categorized into single-barrel (n=126) and double-barrel (n=42) groups.
• Statistical analysis included Chi-square and Student's t-tests to compare outcomes.

Main Results:

• No significant differences in postoperative morbidity, including complications, flap salvage, or mortality, between the two groups.
• Operative time and hospital stay were comparable.
• Primary dental implantation was significantly higher in the double-barrel group (OR 3.02, P=0.019).

Conclusions:

• Double-barrel fibula flap reconstruction is safe and does not increase postoperative morbidity or hospital stay compared to single-barrel.
• The double-barrel technique is associated with significantly higher rates of primary dental implantation.
• This approach should be considered for early dental rehabilitation in mandibular reconstruction.