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Outcome Analysis of Modified End-to-Side Bony Strut Placement for Osteo-Cutaneous Fibular Free Flap Reconstruction of
Sam El Abbadi1,2, Rushil R Dang1,3, Ellen M Lee4
1Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, Linkou, Taiwan.
Background:
Segmental mandibular reconstruction with osteocutaneous fibular free flaps commonly employs end-to-end (E-T-E) wedge osteotomies. However, excessive osteotomies or limited fibular length can compromise vascularity, bony union, available pedicle length. This study evaluates the outcomes of a modified end-to-side (E-T-S) fibular strut configuration in mandibular reconstruction.
Methods:
A retrospective analysis was conducted on 11 patients who underwent mandibular reconstruction using fibular free flaps with at least one E-T-S osteotomy between 2017 and 2021. Bony union was assessed radiographically ≥ 12 months postoperatively and categorized as complete (CBU) or incomplete bony union (IBU). Complication rates were also analyzed.
Results:
Among 33 junctions, 11 were reconstructed using the modified E-T-S approach. Of these, 7 achieved complete bony union. In the remaining 22 junctions reconstructed with E-T-E osteotomies, 15 achieved complete bony union.
Conclusion:
Descriptively, the union rates observed in modified E-T-S osteotomies were similar to those seen in conventional E-T-E reconstructions. It offers a viable alternative in complex reconstructions where pedicle length, anatomy, or perfusion constraints preclude standard approaches.
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