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In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
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Risk Factors for Flap Loss in Midface Reconstruction with Vascularized Fibular Flap.
Katsuhiro Ishida1, Yohjiro Makino1, Keita Kishi1
1Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan.
Journal of Reconstructive Microsurgery
|March 11, 2025
Summary
Vascularized fibular osteomyocutaneous flap (VFOF) is effective for midface reconstruction. Factors like sex and defect classification impact VFOF success, while diabetes increases late complication risk.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oral and Maxillofacial Surgery
Background:
- Midface reconstruction demands attention to both functional and aesthetic outcomes.
- The vascularized fibular osteomyocutaneous flap (VFOF) presents a viable option for complex midface defects.
Purpose of the Study:
- To identify the causes of vascularized fibular osteomyocutaneous flap (VFOF) failure in midface reconstruction.
- To analyze prognostic factors influencing VFOF success and identify risk factors for late complications.
Main Methods:
- Retrospective review of 62 patients undergoing midface defect reconstruction with VFOF (August 2011 - May 2022).
- Primary outcome: VFOF loss within 30 days. Secondary outcomes: late complications (≥6 months post-op).
- Analysis of prognostic factors including sex, defect classification (Brown and Shaw), and comorbidities like diabetes mellitus.
Main Results:
- VFOF failure occurred in 10 (16.1%) patients. Sex and maxillary Brown and Shaw classification were significant prognostic factors for failure.
- Late complications were observed in 11 (23.4%) of 47 followed patients.
- Diabetes mellitus was a significant risk factor for late complications (p < 0.01).
Conclusions:
- Vascularized fibular osteomyocutaneous flap (VFOF) is a suitable technique for midface reconstruction.
- Key surgical considerations include optimal bone placement, pedicle management, tension-free anastomosis, and appropriate flap selection for large defects.
- Diligent postoperative care, particularly nasal care, is crucial for successful outcomes.
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