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Analysis of related factors of long-term complications after vascularized fibular transplantation

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Abstract

Objectives

Free fibula flap is the first choice for jaw reconstruction in head and neck oncology, but postoperative complications in donor site are ignored always. The main purpose of this study was to investigate the long-term complications and potential risk factors of donor site after vascularized fibular transplantation, and to explore the precautions of preparing vascularized fibular flap and the measures of preventing donor site complications.

Materials and methods

Data were retrospectively collected on 31 patients who had undergone immediate mandibular reconstruction with a fibular flap after segmental mandibulectomy from 2013 to 2018 in Shanghai Ninth People’s Hospital. Thirty-one patients (24 male, 7 female) were available for the long-term complications in donor site analysis from 25 to 96 months after surgery. The data were collected and analyzed, including age at time of operation, early postoperative complications, incidence of dorsiflexion weakness of hallux, donor site missing fibula length, proximal and distal stump fibula length, and subjective evaluation of foot function (AOFAS-hallux, AOFAS-ankle hindfoot, Enneking lower limb function score). In the single-factor analysis in this study, the correlation between related factors and long-term complications was statistically analyzed. For inter-group comparisons of quantitative data, if the normal distribution was satisfied, two independent sample t-tests were used; p < 0.05 was statistical significant. If the normal distribution was not satisfied, Wilcoxon rank-sum test was used, and p < 0.05 was considered statistically significant. For qualitative data, the Fisher exact probability method was compared between group differences, and p < 0.05 was statistically significant.

Results

The most commonly encountered complication in our series was dorsiflexion disorder, flexion deformity, numbness of the lateral side of the lower leg, and dorsum of the foot. Ten patients (32.26%) developed hallux flexion deformity after operation, 17 patients (54.84%) had hallux dorsiflexion dysfunction after operation, and 10 patients (32.26%) had numbness of the lateral side of the lower leg and dorsum of the foot. The incidence of hallux dorsiflexion dysfunction, thumb flexion deformity, and sensory disturbance was higher than that of other long-term complications in the donor area. The residual length of fibular distal was related to the dorsiflexion dysfunction and flexion deformity of hallux (p < 0.05). The early complications of donor site were correlated with the hallux dorsiflexion dysfunction (p < 0.05).

Conclusions

The incidence of dorsiflexion disorder and flexion deformity is higher in patients after fibula transplantation. The less the residual length of fibular distal, the more obvious the long-term complications in the donor site, and the higher the incidence of dorsiflexion dysfunction and flexion deformity of hallux.

Clinical relevance

The long-term complications of donor site after fibular transplantation seriously affect the quality of life of patients and provide clinical reference for further reducing the occurrence of donor site complications.

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Funding

This research was supported by the National Natural Science Foundation of China (no. 82170923) and Clinical Research Plan of SHDC” (SHDC2020CR3008A). Project funded by China Postdoctoral Science Foundation (2021TQ0206, 2021M690105).

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Author notes

  1. Hao Wu and Jixiong Mao contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Department of Oral Maxillofacial-Head and Neck Oncology, College of Stomatology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai, 200011, China

    Hao Wu, Zilin Wang, Zhiyong Guo, Yige Liu, Jing Han, Chenping Zhang & Jiannan Liu

  2. Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Jixiong Mao

  3. Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zanjing Zhai

  4. National Clinical Research Center for Oral Diseases, Shanghai, China

    Zilin Wang, Zhiyong Guo, Yige Liu, Jing Han, Chenping Zhang & Jiannan Liu

  5. Shanghai Key Laboratory of Stomatology &, Shanghai Research Institute of Stomatology, Shanghai, China

    Zilin Wang, Zhiyong Guo, Yige Liu, Jing Han, Chenping Zhang & Jiannan Liu

Authors
  1. Hao Wu
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  8. Chenping Zhang
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  9. Jiannan Liu
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Contributions

(I) Conception and design: all authors; (II) administrative support: corresponding author; (III) provision of study materials or patients: all authors; (IV) collection and assembly of data: the first author and common author; (V) data analysis and interpretation: all authors; (VI) manuscript writing: the first author; (VII) final approval of manuscript: all authors.

Corresponding author

Correspondence to Jiannan Liu.

Ethics declarations

Ethics approval

The study protocol was approved by Medical Ethics Committee of the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine (SH9H-2022-T58-1).

Consent to participate

All included patients agreed to use their medical data for research purposes.

Conflict of interest

The authors declare no competing interests.

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Wu, H., Mao, J., Zhai, Z. et al. Analysis of related factors of long-term complications after vascularized fibular transplantation. Clin Oral Invest 26, 6961–6971 (2022). https://doi.org/10.1007/s00784-022-04650-3

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  • DOI: https://doi.org/10.1007/s00784-022-04650-3

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