Mandibular Reconstruction with Vascularized Fibular Graft: Comparing Outcomes of Adjuvant Radiotherapy Versus No-Radiotherapy

Article Information

Title: Mandibular Reconstruction with Vascularized Fibular Graft: Comparing Outcomes of Adjuvant Radiotherapy Versus No-Radiotherapy

Authors: Noshi Bibi, Mamoon Rashid, Saad-ur-Rehman, Haroon-Ur-Rashid, Farwa Shabbir, Sakina Malik

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 5

Language: English

Keywords: RadiotherapyFibular graftMandibular reconstructionNon-unionPlate exposure

Abstract

Objective: To compare the outcomes of mandibular reconstruction with vascularized fibular graft in adjuvant and nonradiotherapy Groups.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Plastic Surgery Department, Shifa International Hospital, Islamabad Pakistan, from 2010 to 2018.
Methodology: The data of 92 patients from 2010-2018 was included. Outcomes regarding local wound complications, wound dehiscence, fistula, skin necrosis, plate exposure and bone union rate were compared in Radiated (IR) and Non-Radiated (NR) Groups. Orthopantomography (OPG) was done at one month, six months, and one-year follow-up and was reviewed by a Radiologist.
Results: Ninety-two patients were included in the study, 56(60.9%) patients in the IR-Group and 36(39.1%) patients in the NRGroup. In the IR-Group, 56(60.9%) causes were intraoral squamous cell carcinoma in 51(91.0%) cases and osteosarcoma in 5(9.0%) cases. In NR-Group cases were ameloblastoma (15,41.6%), giant cell tumor (4,11.1%), craniofacial microsomia(4,11.1%), osteonecrosis (6,16.6%) and trauma (7,19. 4%). Common complications were plate exposure (2.1%), wound breakdown (10.8%) in the IR-Group, and, on the other hand, in the NR Group, wound breakdown noted in (3.2%) respectively(p=0.05).
Conclusion: With our experience, adjuvant radiation is an important modality that increases survival rate and can be safely administered without any significant complications related to soft tissue and reconstructed bone.

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Research Objective

To compare the outcomes of mandibular reconstruction with vascularized fibular graft in patients who received adjuvant radiotherapy versus those who did not.

Methodology

Retrospective longitudinal study involving 92 patients who underwent mandibular reconstruction with a vascularized fibular graft between 2010 and 2018. Outcomes such as local wound complications, wound dehiscence, fistula, skin necrosis, plate exposure, and bone union rate were compared between the Irradiated (IR) and Non-Radiated (NR) groups. Orthopantomography (OPG) was used for follow-up at one month, six months, and one year.

Methodology Flowchart

                        graph TD
    A["Patient Data Collection 2010-2018"] --> B["Patient Grouping"];
    B --> C["IR Group Adjuvant Radiotherapy"];
    B --> D["NR Group No Radiotherapy"];
    C --> E["Outcome Assessment Complications, Bone Union"];
    D --> E;
    E --> F["Orthopantomography OPG Follow-up"];
    F --> G["Data Analysis"];
    G --> H["Comparison of Outcomes"];
    H --> I["Conclusion"];

Discussion

The study highlights that free vascularized fibular flaps are a reliable and effective method for mandibular reconstruction, particularly for large defects. While some complications like plate exposure and wound breakdown were observed, they were not significantly different between the irradiated and non-irradiated groups. The findings suggest that adjuvant radiotherapy does not negatively impact bone healing or graft viability in mandibular reconstruction with vascularized fibular grafts.

Key Findings

- 92 patients were included: 56 (60.9%) in the IR-Group and 36 (39.1%) in the NR-Group.
- Common complications in the IR-Group included plate exposure (2.1%) and wound breakdown (10.8%).
- In the NR-Group, wound breakdown was noted in 3.2% of cases.
- Radiodensity of bone grafts showed good results in both groups at one month, six months, and one year, with no significant difference observed between the IR and NR groups.
- Adjuvant radiation was found to be a safe modality without significant complications related to soft tissue and reconstructed bone.

Conclusion

Adjuvant radiotherapy can be safely administered to head and neck cancer patients undergoing mandibular reconstruction with vascularized fibular grafts. Complication rates were not significantly different between the irradiated and non-irradiated groups, and good bony healing was observed in both. The free fibula flap remains an ideal choice for mandibular reconstruction.

Fact Check

- 92 patients were included in the study. (Confirmed in Results section)
- 56 patients (60.9%) were in the Irradiated (IR) group. (Confirmed in Results section)
- Wound breakdown was noted in 10.8% of cases in the IR-Group. (Confirmed in Results section)

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