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Factors Associated with Post-Operative Complications in Pediatric Mandible Reconstruction Using Vascularized Free Fibula Flaps
Theodor B. Lenz, BA, Dominic J. Romeo, MA, MTS, Jacob R. Thomas, BS, Patrick Akarapimand, BS, Meagan Wu, MA, Jinggang J. Ng, MA, Benjamin B. Massenburg, MD, Jesse A. Taylor, MD, Scott P. Bartlett, MD, Jordan W. Swanson, MD MScn
Children's Hospital of Philadelphia, USA
Background: Free fibula transfers can treat severe mandibular defects, but little is known about risk factors contributing to post-operative complication profiles in pediatric populations. This study aims to address this gap by identifying factors associated with complications following free fibula reconstruction of the mandible in pediatric patients.
Methods: We retrospectively reviewed patients who underwent mandibular reconstruction using vascularized free fibula flaps between 11/2001-03/2024. Complication severity was stratified by the Clavien-Dindo scale. Demographic information, surgical techniques, and complications were analyzed using t-tests and chi-square analysis.
Results: Twenty-one patients underwent 24 mandibular reconstructions using vascularized free fibula flaps at an average age of 11.9 years old (range: 3.5-18.2 years). Ten (41.6%) operations resulted in a total of 14 independent complication events. Two (14.3%) events were class II, 11 (78.6%) were class III, and one (7.1%) was class IV. Twenty-one (87.5%) flaps were successful. Patients younger than 11.9 years old had significantly more flap failures than those older than 11.9 years old (p=0.028). Patients younger than 11.9 years old also had more post-operative complications (p=0.04). Most patients older than 11.9 years old had reconstruction of the mandible following tumor resection (p<0.001). The facial artery was the recipient artery in 12 out of 14 (85.7%) patients under the age of 11.9 years old compared to 2 out of 10 (20%) patients over 11.9 (p=0.001). No patient younger than 11.9 required more than one venous anastomosis while 6 of 14 (42.9%) over 11.9 required more than one venous anastomosis (p<0.05).
Conclusion: Younger age at operation is associated with increased post-operative complications and graft failures in pediatric patients undergoing mandibular reconstruction using free fibula flaps. Factors such as syndromic indications and arteriovenous anastomosis choices warrant further investigation as possible contributing factors to post-operative complications and graft failure.
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