ASSESSMENT OF PREDICTING SUCCESS FACTORS OF MICROVASCULAR COMPOSITE FIBULA FLAP IN RECONSTRUCTION OF HARD AND SOFT TISSUE DEFECTS IN MAXILLOFACIAL AND ORAL CAVITY DUE TO PREVIOUS BALLISTIC TRAUMA
Main Article Content
Keywords
Vascular anastomosis, traumatic defects, reconstruction, confounding factors
Abstract
Background and objective
Reconstruction with fibula free-flap is one of the routine treatments in head and neck surgeries. The present research was done to determine the predictor factors of success of vascular anastomosis in composite free fibula microvascular flaps or fibula free flaps used in the reconstruction of traumatic/ballistic oral and maxillofacial defects among the patients referring to Taleghani hospital in Tehran in 2022 and 2023.
Materials and methods
The present research was done via a prospective cohort method on 14 patients. The demographic information, characteristics related to trauma surgery, characteristics associated with the treatment outcomes including success of the flap, incidence of infection, hematoma, and thrombosis at the transplantation site, as well as the site of arterial and venous anastomosis were recorded. Comparison of the quantitative variables was done using independent t-test and Mann-Whitney U test, with the results of qualitative variables judged via chi-square test.
Results
The success of flap was observed in 78.6% (n=11) subjects. Bleeding was seen in two cases (14.3%), surgical site infection in five patients (35.7%), hematoma in one patient (7.1%), and thrombosis in five patients (35.7%). Considering the site of venous and arterial anastomosis, 13 cases (92,9%) were in the form of end to end, and one case (7.1%) was in the form of end to side. No significant difference was observed in terms of frequency of the cases of flap success, infection, hematoma, thrombosis per the transplant and site of arterial anastomosis, type of artery, and anastomosis vein at the recipient site, location of defects, gender, and time between trauma and surgery. Nevertheless, the values of systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), as well as oxygen saturation percentage (p=0.001) were significantly higher in successful flap cases. Furthermore, smoking tobacco had caused significant reduction in flap success (p=0.02).
Conclusion
Overall, transplantation of composite microvascular flap or fibular free flap has been associated with successes in reconstruction of oral and maxillofacial traumatic defects. However, there are some concerns about the role of some variables such as systolic blood pressure, diastolic blood pressure, as well as oxygen saturation percentage, and smoking tobacco in this regard.
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Elahe Tahmasebi
Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
Reza Tabrizi
Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohsen Yazdanian
Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
Shervin Shafiei
Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hamidreza Moslemi
Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Hosein Kalantar Motamedi
Professor, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
Fateme Mozaffari
Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
Arman Torabizadeh
Oral and Maxillofacial surgeon, Private Practice, Tehran, Iran