Fibular free flaps for mandibular reconstruction: symphysis is at higher risk

To identify variables involved in fibular free flap (FFF) loss in mandibular reconstruction. The database was prospectively collected; few data were obtained retrospectively from surgical records. Variables considered in identifying factors affecting FFF loss in mandibular reconstruction included: patient related generalities (age, gender, ASA score, tumor type, pre-surgical radiation or previous same site surgery), mandible defect to be reconstructed, pedicle orientation to reach the recipient vessels, variables in vascular micro-anastomoses (double versus single and deep or superficial vein drainage, presence of grafts for vascular anastomoses, ischemia time which depended on in situ modeling or not), micro-vascular re-exploration. Descriptive statistics, chi-square tests, odds-ratio and multivariate logistic regression. 42 patients with average age of 61 (± 14) years, 59.5% males: 35 had a squamous cell carcinoma, 7 benign (locally aggressive) lesions. The preferred recipient vessel was the facial artery. Significant factors for flap failure risk included double free flap reconstruction, mandibular tract reconstruction (symphysarian region), use of grafts. The cut-off for a safe ischemia time was 30 minutes. Flap revision within an adequate post-surgical flap monitoring was crucial to prevent flap failure. Our data analysis was able to identify variables impacting flap survival.