Optimizing outcomes in pediatric microvascular mandibular reconstruction: A 23-year institutional experience

Area of Science:

• Pediatric reconstructive surgery
• Oral and maxillofacial surgery
• Microsurgery

Background:

• Vascularized free fibula flap (VFFF) is a standard for critical-sized mandibular defects, including in pediatric cases.
• Understanding surgical risks and growth impacts in skeletally immature patients requires further investigation.
• Optimizing growth and outcomes in pediatric mandibular reconstruction remains a key challenge.

Purpose of the Study:

• To evaluate the safety and efficacy of VFFF for pediatric mandibular reconstruction.
• To identify risk factors affecting outcomes and growth potential in pediatric patients.
• To determine methods for optimizing results in this patient population.

Main Methods:

• Retrospective review of pediatric patients undergoing VFFF mandibular reconstruction (2001-2024).
• Complication classification using the Clavien-Dindo scale.
• Statistical analysis including correlation and chi-squared tests.

Main Results:

• 31 VFFFs performed in 29 pediatric patients (median age 14 years); 94% flap success rate.
• Complications (e.g., hardware exposure) decreased with institutional experience and use of dual venous anastomoses.
• Recipient site complications were more frequent in patients under 12 years old.

Conclusions:

• Vascularized free fibula flap (VFFF) reconstruction is safe and effective for pediatric mandibular defects, preserving functional occlusion during growth.
• Complication rates are comparable to adults and can be reduced through dual venous anastomoses and accumulated institutional experience.
• The technique supports continued facial growth, with some patients requiring subsequent orthognathic surgery.