Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction

Chad A. Zender, Vikas Mehta, Amy L. Pittman, Paul J. Feustel, James J. Jaber

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives/Hypothesis: To evaluate perioperative complications in a homogeneous cohort undergoing microvascular osteocutaneous free flap (OCFF) reconstruction following segmental mandibulectomy for advanced oral cancer and to identify the causes of late OCFF failures. Study Design: Retrospective chart review. Methods: The records of 65 adults who underwent a segmental mandibulectomy for primary oral cavity cancer followed by single-stage reconstruction OCFF were reviewed. Early and late complications were identified and their associations to patients' independent variables and to each other were analyzed to assess etiologic causes of late OCFF failure. Results: The incidence of early and late complications mirrored each another at 29%, and a 95% early-success rate was achieved. An early complication did predict an early infection (odds ratio [OR], 63.3; 95% confidence interval [CI], 6.8-585.3). Furthermore, an early perioperative infection impacted the incidence of late complications (OR, 4.8; 95% CI, 1.3-18.3), and moreover severely impacted the incidence of osteomyelitis/osteoradionecrosis (OR, 8.8; 95% CI, 1.8-41.9) and late failures (OR, 12.8; 95% CI, 1.9-84.5). Conclusions: Mandibular reconstruction following segmental mandibulectomy provides immediate restoration but is often plagued with perioperative complications that are difficult to predict. Early perioperative infections impact patient long-term morbidity by increasing the risk of late graft failure by almost 13-fold. Consequently, it is felt that early aggressive treatment of these infections may reduce the incidence and severity of late complications and improve patient outcomes.

Original languageEnglish (US)
Pages (from-to)1474-1479
Number of pages6
JournalLaryngoscope
Volume122
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Free Tissue Flaps
Mouth Neoplasms
Mandibular Osteotomy
Mouth
Odds Ratio
Confidence Intervals
Incidence
Infection
Osteoradionecrosis
Mandibular Reconstruction
Osteomyelitis
Retrospective Studies
Morbidity
Transplants
Therapeutics

Keywords

  • Advanced oral cavity cancer
  • etiology of late graft failures
  • osteocutaneous free flap
  • reconstruction

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction. / Zender, Chad A.; Mehta, Vikas; Pittman, Amy L.; Feustel, Paul J.; Jaber, James J.

In: Laryngoscope, Vol. 122, No. 7, 07.2012, p. 1474-1479.

Research output: Contribution to journalArticle

Zender, Chad A. ; Mehta, Vikas ; Pittman, Amy L. ; Feustel, Paul J. ; Jaber, James J. / Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction. In: Laryngoscope. 2012 ; Vol. 122, No. 7. pp. 1474-1479.
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abstract = "Objectives/Hypothesis: To evaluate perioperative complications in a homogeneous cohort undergoing microvascular osteocutaneous free flap (OCFF) reconstruction following segmental mandibulectomy for advanced oral cancer and to identify the causes of late OCFF failures. Study Design: Retrospective chart review. Methods: The records of 65 adults who underwent a segmental mandibulectomy for primary oral cavity cancer followed by single-stage reconstruction OCFF were reviewed. Early and late complications were identified and their associations to patients' independent variables and to each other were analyzed to assess etiologic causes of late OCFF failure. Results: The incidence of early and late complications mirrored each another at 29{\%}, and a 95{\%} early-success rate was achieved. An early complication did predict an early infection (odds ratio [OR], 63.3; 95{\%} confidence interval [CI], 6.8-585.3). Furthermore, an early perioperative infection impacted the incidence of late complications (OR, 4.8; 95{\%} CI, 1.3-18.3), and moreover severely impacted the incidence of osteomyelitis/osteoradionecrosis (OR, 8.8; 95{\%} CI, 1.8-41.9) and late failures (OR, 12.8; 95{\%} CI, 1.9-84.5). Conclusions: Mandibular reconstruction following segmental mandibulectomy provides immediate restoration but is often plagued with perioperative complications that are difficult to predict. Early perioperative infections impact patient long-term morbidity by increasing the risk of late graft failure by almost 13-fold. Consequently, it is felt that early aggressive treatment of these infections may reduce the incidence and severity of late complications and improve patient outcomes.",
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